tag:theconversation.com,2011:/us/topics/chronic-diseases-464/articlesChronic diseases – The Conversation2024-02-05T05:12:15Ztag:theconversation.com,2011:article/2196122024-02-05T05:12:15Z2024-02-05T05:12:15ZMillions of Australians have a chronic illness. So why aren’t employers accommodating them?<figure><img src="https://images.theconversation.com/files/573331/original/file-20240205-22-173q39.jpg?ixlib=rb-1.1.0&rect=35%2C188%2C5955%2C3799&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-working-in-a-factory-with-a-lot-of-boxes-NixrmlDt-6E">Kat von Wood/Unsplash</a></span></figcaption></figure><p><a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/health-conditions-prevalence/2022">More than 20 million Australians</a> have at least one long-term health condition, <a href="https://www.abs.gov.au/statistics/labour/employment-and-unemployment/barriers-and-incentives-labour-force-participation-australia/latest-release#data-downloads">63%</a> of whom are in the workforce. </p>
<p>The <a href="https://www.health.gov.au/topics/chronic-conditions/about-chronic-conditions">causes of chronic illness</a> are complex and are often unconnected to a person’s work. But at times, the continued exposure to work stressors can lead to or exacerbate chronic health conditions including <a href="https://www.ccohs.ca/oshanswers/psychosocial/musculoskeletal.html">musculoskeletal disorders</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674745/">heart disease</a>, <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-8-280">anxiety</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/18417557/">depression</a>. </p>
<p><a href="https://apo.org.au/node/322034">Our research</a> found 73% of people believed their chronic illness was at least partially caused or worsened by their job. Almost one in five people believed work entirely caused or worsened their illness. </p>
<p>These findings accord with data from <a href="https://data.safeworkaustralia.gov.au/insights/key-whs-stats-2023">Safe Work Australia</a> which indicates health conditions (particularly mental health) account for an increasing proportion of serious workers’ compensation claims.</p>
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<p>Our research <a href="https://apo.org.au/node/322034">also found</a> people with chronic illness were likely to report various forms of workplace discrimination, including being rejected from a job (63%), being treated unfairly in the workplace (65%) and harassment (52%). </p>
<p>So what are employers getting so wrong? And what are the solutions to improving working conditions for people with chronic illnesses? </p>
<h2>Employers’ responsibilities have grown</h2>
<p>In 2022, <a href="https://www.safeworkaustralia.gov.au/doc/model-whs-regulations">Safe Work Australia</a> updated its work health and safety regulations to include specific guidelines on the management of “psychosocial” hazards in the workplace. </p>
<p>A <a href="https://www.safeworkaustralia.gov.au/doc/model-whs-regulations">psychosocial hazard</a> is anything that can cause psychological and physical harm, including the design or management of work and workplace interactions or behaviours. </p>
<p>Common examples include job demands, low job control, poor support, lack of role clarity, exposure to traumatic events, harassment and bullying. The failure to eliminate or minimise psychosocial hazards can cause work-related stress, resulting in poor health outcomes for workers.</p>
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<img alt="Waiter sets table" src="https://images.theconversation.com/files/573334/original/file-20240205-27-wkdls6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573334/original/file-20240205-27-wkdls6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573334/original/file-20240205-27-wkdls6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573334/original/file-20240205-27-wkdls6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573334/original/file-20240205-27-wkdls6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573334/original/file-20240205-27-wkdls6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573334/original/file-20240205-27-wkdls6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Employers have an obligation to manage psychosocial hazards.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/man-in-white-top-standing-next-to-table-OB7ol699Iww">Chuttersnap/Unsplash</a></span>
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<p>Organisations need to improve their engagement and management of chronically ill workers to meet their legal obligations. </p>
<h2>How employers are getting it wrong</h2>
<p>Few organisations have sophisticated approaches to <a href="https://link.springer.com/article/10.1186/1472-6963-11-104">managing employees who are chronically ill</a>. And managers often feel <a href="https://hbr.org/2021/02/how-managers-can-support-employees-with-chronic-illnesses">ill-equipped</a> to effectively support chronically ill employees. </p>
<p>Instead, there is a tendency to rely on outmoded human resource and occupational health and safety systems originally designed to accommodate short-term absences and acute illnesses. </p>
<p><a href="https://theconversation.com/how-employers-can-help-cancer-survivors-return-to-work-based-on-my-own-experience-128568">Return-to-work</a> policies tend to fall short because they assume a phased and linear return to full working capacity. This is often not the case for people with chronic illness, whose symptoms may be degenerative or fluctuate over time. </p>
<p>Chronically ill workers are <a href="https://www.researchgate.net/profile/Joy-Beatty/publication/256924077_An_Overlooked_Dimension_Of_Diversity_The_Career_Effects_of_Chronic_Illness/links/5b8887b94585151fd13dc5cf/An-Overlooked-Dimension-Of-Diversity-The-Career-Effects-of-Chronic-Illness.pdf">rarely considered</a> in organisational diversity and inclusion policies and procedures. At best, they may be incorporated into umbrella disability policies, which can be problematic as people with chronic illness do not necessarily <a href="https://chronicillnessinclusion.org.uk/wp-content/uploads/2021/12/DRUK-CII-survey-report-Nov-2021.pdf">self-identify as “disabled”</a>. </p>
<p>Many chronically ill workers fly under the radar. This is partly because organisations don’t collect this data but it’s also due to the often invisible nature of chronic illness. Someone living with conditions such as long COVID or endometriosis, for example, may present as unimpaired to their colleagues. However, they will often be dealing with complex, fluctuating symptoms that are largely invisible at work. </p>
<p>Workers may also choose <a href="https://hbr.org/2023/08/research-when-leaders-disclose-a-chronic-illness-at-work">not to disclose</a> their illness due to fears of being stigmatised, treated differently, or passed over for promotion. <a href="https://fbe.unimelb.edu.au/__data/assets/pdf_file/0007/4639318/Disclosing_Illness_at_Work_Ghin_Ainsworth.pdf">Our research</a> on leaders living with chronic illness found only 18% fully disclosed their illness to their employer. Almost three-quarters of leaders with chronic illness (73%) deliberately hid their illness at work. </p>
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Read more:
<a href="https://theconversation.com/should-you-tell-your-boss-about-your-mental-illness-heres-what-to-weigh-up-200907">Should you tell your boss about your mental illness? Here's what to weigh up</a>
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<h2>What can employers do?</h2>
<p>Here are three ways employers can begin to proactively meet their obligations to workers with chronic illness. </p>
<p><strong>1. Make adjustments</strong> </p>
<p>Workers with chronic illness sometimes experience fluctuations in their condition which can impact their ability to complete tasks or meet deadlines. It may be necessary for managers to consider sensitively discussing a revised work schedule, the delegation of time-sensitive tasks, or discuss implementing reasonable adjustments to improve workflow.</p>
<p>These can be challenging conversations, but engaging with them directly means employers can allocate the resources they need to meet their business objectives, while also reducing employee experiences of overwhelm.</p>
<p><strong>2. Accept reasonable requests</strong></p>
<p>Workers with chronic illness may require reasonable adjustments, such as flexible working, to enable them to perform to the best of their ability. </p>
<p>Take these requests at face value and minimise the administrative hurdles associated with approving such accommodations. Failing to do so is likely to erode trust, entrench feelings of not being supported and increase an employee’s psychological distress. </p>
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<img alt="Woman puts sticky notes on whiteboard" src="https://images.theconversation.com/files/573332/original/file-20240205-23-ofrizq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573332/original/file-20240205-23-ofrizq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573332/original/file-20240205-23-ofrizq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573332/original/file-20240205-23-ofrizq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573332/original/file-20240205-23-ofrizq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573332/original/file-20240205-23-ofrizq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573332/original/file-20240205-23-ofrizq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Accepting reasonable requests will make employers feel supported.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-placing-sticky-notes-on-wall-Oalh2MojUuk">Jason Goodman/Unsplash</a></span>
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<p><strong>3. Train managers</strong></p>
<p>Managers may sometimes deny a request for a reasonable adjustment based on the belief that this creates a precedent for all team members. Decisions like these can compound feelings of stress, as they may be experienced as a lack of procedural fairness by employees living with chronic illness. </p>
<p>With appropriate training, managers are more likely to recognise that chronically ill workers are generally not seeking “special treatment”, but ways to work more effectively within their changed capacities.</p>
<p>By recognising the value of employees of all abilities, and proactively and systematically addressing the needs of their chronically ill workforce, employers can minimise extended workplace absences and improve the productivity of their workforce. </p>
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<img src="https://counter.theconversation.com/content/219612/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Employers have a duty to address work stressors and make adjustments for workers with long-term illnesses.Peter Ghin, Research fellow, Future Of Work Lab, Faculty of Business and Economics, The University of MelbourneSusan Ainsworth, Professor of Management and Marketing, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172642024-01-28T19:05:20Z2024-01-28T19:05:20ZMedicare turns 40: since 1984 our health needs have changed but the system hasn’t. 3 reforms to update it<figure><img src="https://images.theconversation.com/files/571353/original/file-20240125-29-9x8icz.jpg?ixlib=rb-1.1.0&rect=0%2C57%2C7719%2C4513&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/selective-focus-photography-of-assorted-color-balloons-Hli3R6LKibo">Ali Goldstein/Unsplash</a></span></figcaption></figure><p>Forty years ago, Medicare as we know it today was born. It was the reincarnation of the Whitlam government’s Medibank, introduced in 1975 but <a href="https://www.sciencedirect.com/science/article/abs/pii/0277953684902661">dismantled</a> in stages by the Fraser Liberal government. </p>
<p>Medibank was developed in the 1960s by health economists <a href="https://grattan.edu.au/news/remebering-richard-scotton-co-founder-of-medicare/">Dick Scotton</a> and <a href="https://openresearch-repository.anu.edu.au/bitstream/1885/159512/1/Daring_to_Dream.pdf">John Deeble</a>, when disease prevalence was different and the politics of reform were diabolical. </p>
<p>But the nation has changed since 1984, and so have our health needs. Medicare is now struggling to ensure the access to health care for millions of Australians we were once promised. </p>
<p>Let’s look at how we got here – and three radical changes we need to keep the Medicare promise into the future: making it cheaper to see a GP; paying less for blood and imaging tests; and covering dental care. </p>
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<a href="https://theconversation.com/if-you-live-in-a-bulk-billing-desert-its-hard-to-see-a-doctor-for-free-heres-how-to-fix-this-204029">If you live in a bulk-billing ‘desert’ it's hard to see a doctor for free. Here's how to fix this</a>
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<h2>Free hospital care, but you might pay to see a GP</h2>
<p>One of my first jobs in the health system, in the days before Medicare and Medibank, was acting in charge of revenue collection for three public hospitals. A small subset of people could get free, albeit stigmatised, care. </p>
<p>We had bad debts, because some people couldn’t afford to pay their hospital bills and I was allowed by policy to recommend that some be written off. But for others I had to seek court authorisation to seize their wages to pay off their hospital debt. </p>
<p>Medibank changed that. Now all Australians can get public hospital care without any financial barrier.</p>
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<img alt="Doctor draws blood from patient" src="https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Before Medicare and Medibank, patients often faced hospital care debts.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-laying-in-a-hospital-bed-next-to-a-man-dkZQfm1LLQE">National Cancer Institute/Unsplash</a></span>
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<p>But the financial barriers to seeing a GP or a private specialist (out of hospital) have remained. Doctors continue to charge what they like, with Medicare often only covering a portion of their fees. This has left many patients facing significant out-of-pocket payments.</p>
<p>When Medicare was designed, medical care was provided mostly by solo medical practitioners working in practices they owned. It was a one-to-one professional relationship, with the patient paying the practitioner for each service. </p>
<p>Over time, general practice evolved into group practices organised as partnerships. Next, they <a href="https://onlinelibrary.wiley.com/doi/10.5694/mja2.51038">consolidated and corporatised</a>. A handful of corporates now provide all <a href="https://www.accc.gov.au/system/files/public-registers/documents/ACL%20Healius%20%20-%20Statement%20of%20Issues.pdf">private pathology</a> (which tests blood and other tissues) and <a href="https://www.jacr.org/article/S1546-1440(07)00614-X/fulltext">radiology</a> (which provides imaging services) and a large proportion of GP care. </p>
<p>Corporates have not made the same inroads into most other specialties. But since the 1980s, states have reduced public hospital outpatient services. So patients are now more reliant on private medical specialists for care referred by their GP.</p>
<h2>Much has changed, but cost of living pressures remain</h2>
<p>Health-care needs have changed. As we live longer, we live with more diseases, many of which are chronic. The care required increasingly involves many different health providers and includes non-medical specialties such as podiatry, physiotherapy and psychology. </p>
<p>When Medicare was introduced, university education was offered for only a few of these professions. But their training has evolved and so too what they can do. This is particularly the case for nursing. It has evolved from an apprenticeship model to a profession with its own specialties. A subset – nurse practitioners – have the authority to diagnose and prescribe medication.</p>
<p>Broader technology trends have also had an impact on health care, as with all other sectors. Virtual care and telehealth <a href="https://theconversation.com/what-can-you-use-a-telehealth-consult-for-and-when-should-you-physically-visit-your-gp-135046">proved their worth</a> during the early years of the COVID pandemic, just as generative AI is beginning to show its promise now.</p>
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<p>Medicare was first and foremost about efficiently removing financial barriers to access. It was introduced as part of an <a href="https://www.jstor.org/stable/20635272">agreement with the Labor movement</a> about reducing costs of living and, in particular, ensuring people could attend a doctor without having to worry about how they would pay for the visit.</p>
<p>However, <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/2022-23#data-downloads">about 1.2 million Australians</a> deferred or missed out on seeing a GP because of cost in the 2022-23 financial year. Lower-income Australians have higher rates of missing out on care. </p>
<p>Medical fees aren’t regulated and so consumers face a lottery – not knowing whether a fee will be charged and having no control over that decision. Only about 52% of all Australians were <a href="https://www.health.gov.au/sites/default/files/2023-08/medicare-statistics-per-patient-bulk-billing-dashboard-2022-23.pdf">always bulk-billed</a> in 2022-23, down from 66% a year earlier. </p>
<p>So how can we get Medicare back on track towards its goal of universal health care for all Australians? Here are three radical reforms we should prioritise. </p>
<h2>1. Make GP care affordable for all</h2>
<p>Rebates are currently subject to political whim. The Liberal government (in office from 2013 to 2022) froze rebates, leading to increases in average out-of-pocket payments and reduced bulk-billing.</p>
<p>The first step in reducing costs as a barrier to GP care should be introduction of independent fee-setting. </p>
<p>Canadian Medicare – which was the model for Australia’s system – mostly has <a href="https://journals.sagepub.com/doi/full/10.1177/0840470421994304">no out-of-pocket payments</a>. Fees are set by negotiations, not politicians’ whims, and this is <a href="https://laws-lois.justice.gc.ca/eng/acts/C-6/page-1.html#h-151558">enshrined in legislation</a>. </p>
<p>With independent fee-setting in place, a new scheme of “participating providers” should be introduced. Under such a scheme, practices would bulk-bill everyone, and participate in agreed quality-improvement programs.</p>
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Read more:
<a href="https://theconversation.com/what-if-medicare-was-restricted-to-gps-who-bulk-billed-this-kind-of-reform-is-possible-203543">What if Medicare was restricted to GPs who bulk billed? This kind of reform is possible</a>
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<p>If fees are set independently and fairly, extra billing over and above the fee is unjustifiable. Non-participating practices would not be eligible for Medicare benefits. </p>
<p>It’s anticipated the vast majority of practices would agree to participate. In Canada, the participation rate is roughly 100%, and bulk billing in Australia is <a href="https://www.health.gov.au/resources/publications/medicare-quarterly-statistics-bulk-billing-by-primary-health-network-september-quarter-2023-24">still over 75%</a>.</p>
<p>Participating practices should also be eligible for additional grants to employ other health professionals to provide a more comprehensive range of services – such as physiotherapists and psychologists – to meet the contemporary needs of a population with increasing chronic illness. </p>
<p>If successful, these changes would mean all Australians can access a GP and other primary care services without any out-of-pocket costs.</p>
<h2>2. Deal with diagnostics</h2>
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<img alt="Blood vials" src="https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The cost of processing tests varies.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/green-pink-and-purple-plastic-bottles-0jE8ynV4mis">Testalize.me/Unsplash</a></span>
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<p>Despite the evolution of ownership and market structures, pathology and radiology services are still reimbursed by fees for each service (with complex rules about rebates when multiple tests are performed simultaneously). </p>
<p>But while both industries are expensive to set up and buy or lease equipment, the cost of processing an additional test or image is low and sometimes close to zero. This means Medicare pays pathology and radiology providers much more than the tests or images cost.</p>
<p>Both industries are also ripe for further technological change, with the quality of generative AI rapidly improving, and costs likely to further reduce.</p>
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Read more:
<a href="https://theconversation.com/blood-money-pathology-cuts-can-reduce-spending-without-compromising-health-54834">Blood money: pathology cuts can reduce spending without compromising health</a>
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</p>
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<p>The uncapped fee-for-service model for pathology and radiology needs to be replaced by one in which the benefits of technological change are shared between shareholders and taxpayers, rather than all accruing to the former. </p>
<p>This could be done by replacing fee-for-service payments with a payment model used in the corporate world. Private and public providers could be <a href="https://grattan.edu.au/report/blood-money-paying-for-pathology-services/">invited to tender</a> to provide these services in certain areas, with conditions around geographic access, quality and no out-of-pocket payments for consumers. </p>
<p>The same model could also apply to other technology-intensive types of health care, such as radiotherapy for cancer.</p>
<p>These changes might be cost-neutral for government, and save consumers the $24 they currently pay out of pocket on every pathology test that is not currently bulk-billed and $122 on each non-bulk-billed diagnostic imaging test.</p>
<h2>3. Cover dental care too</h2>
<figure class="align-center ">
<img alt="Boy undergoes dental treatment" src="https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dental care is largely unaffordable.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/boy-in-blue-long-sleeve-shirt-drinking-from-a-feeding-bottle-loBRFqXm1QA">Lafayett Zapata Montero/Unsplash</a></span>
</figcaption>
</figure>
<p>A major omission from Medicare from the start, and a source of continuing inequity, is oral health care. More than two million Australians <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/2022-23#data-downloads">missed out</a> on oral health care because of cost in 2022-23.</p>
<p>A new scheme to <a href="https://grattan.edu.au/report/filling-the-gap/">slowly expand universal protection</a> against the costs of oral health care should be phased in over the next decade. This would eventually mean all preventive and basic dental care would be available for everyone, with no out-of-pocket payments. </p>
<p>This would require a parallel expansion of the oral health workforce (dentists and <a href="https://www.dentalboard.gov.au/Registration/Oral-Health-Therapist.aspx">oral health therapists</a>) and development of new payment models based on a participating practice model rather than simply introducing another unregulated schedule of oral health fees paid via Medicare.</p>
<p>Innovation <a href="https://www.health.gov.au/sites/default/files/2023-12/nhra-mid-term-review-final-report-october-2023.pdf">needs to be built into the Australian health system</a>. However, the foundations for innovation must be based on Medicare’s founding principles of addressing financial barriers to provide universal and equitable health care to all Australians. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/expensive-dental-care-worsens-inequality-is-it-time-for-a-medicare-style-denticare-scheme-207910">Expensive dental care worsens inequality. Is it time for a Medicare-style 'Denticare' scheme?</a>
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</p>
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<img src="https://counter.theconversation.com/content/217264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett, like all Australians, benefits from Medicare.</span></em></p>The health care world has changed a lot in 40 years, but Medicare hasn’t. Here are three areas for radical forms to the system that will achieve its aims of universal health care for all Australians.Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2198782023-12-19T23:42:53Z2023-12-19T23:42:53ZOral health is health: Better access to dental care may have potential benefits beyond Canadians’ mouths<figure><img src="https://images.theconversation.com/files/566686/original/file-20231219-15-3hv10x.jpg?ixlib=rb-1.1.0&rect=688%2C22%2C4303%2C2964&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Because oral health is linked to overall health, dental care needs to be viewed as an integral part of health care. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/oral-health-is-health-better-access-to-dental-care-may-have-potential-benefits-beyond-canadians-mouths" width="100%" height="400"></iframe>
<p>Oral diseases, particularly dental decay and periodontal (gum) diseases, are largely preventable, yet are some of the <a href="https://www.who.int/data/gho/data/themes/oral-health-data-portal">most common non-communicable diseases around the world</a>. Pain due to untreated dental decay impacts eating and sleep quality, among other essential functions. Indeed, the agonizing nature of dental pain earned it the title of “<a href="https://doi.org/10.1038/sj.bdj.4809302">the hell of all diseases</a>” more than 200 years ago.</p>
<p>But pain is only the most obvious of the many ways oral health is linked to overall health.</p>
<h2>Access to dental care</h2>
<p>The federal government recently launched the long-anticipated <a href="https://www.canada.ca/en/services/benefits/dental/dental-care-plan.html">Canada Dental Care Plan</a> (CDCP) to improve access to dental care for the almost <a href="https://www.canada.ca/en/health-canada/news/2023/12/the-canadian-dental-care-plan.html">nine million Canadians</a> who lack dental insurance.</p>
<p>The program comes in light of the increasing barriers to dental care with the most recent data from Statistics Canada showing that <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/231106/dq231106a-eng.htm">one in four Canadians avoid seeing a dental professional due to costs</a>. While this burden affects mostly low-income families, seniors and people living with disabilities, it also places a huge toll on the population as a whole.</p>
<p>On top of the time lost from school or work due to dental problems, many without the means to access dental care end up seeking care in hospital emergency departments, unnecessarily costing the health-care system billions of dollars.</p>
<p>The CDCP is an important milestone that could eventually get many Canadians the dental care they need and deserve. Meanwhile, this investment in oral health is a reminder of the importance of a healthy mouth, what makes it fundamental to overall health, and notably, how the potential impact of improving access to dental care for those who need it most may extend beyond the mouth.</p>
<h2>Oral health is integral for overall health</h2>
<p>The <a href="https://www.who.int/health-topics/oral-health#tab=tab_1">World Health Organization</a> (WHO) defines oral health as “the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompassing psychosocial dimensions such as self-confidence, well-being, and the ability to socialize and work without pain, discomfort and embarrassment.”</p>
<p>A healthy, disease-free mouth is key to quality of life and well-being. Being fundamental to various essential functions, the lack of oral health connects it to a number of chronic diseases in several ways.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/filling-the-gaps-why-canada-still-needs-a-public-dental-health-plan-despite-decades-of-medicare-181306">Filling the gaps: Why Canada still needs a public dental health plan despite decades of medicare</a>
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<p>The most <a href="https://iris.who.int/bitstream/handle/10665/373542/9789240070820-eng.pdf?sequence=1">recent WHO report</a> shows that dental decay and gum diseases affect almost 25 per cent of Canadian adults — a higher figure than that observed in the United States. Importantly, both conditions are among the most common causes of tooth loss in adults globally, thereby impacting the ability to eat, the quality of nutrition and, in seniors, <a href="https://doi.org/10.1111/jgs.16377">contributing to frailty</a> and <a href="https://doi.org/10.1111/jgs.13190">declining cognitive health</a>.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/uMVgyZcH1ig?wmode=transparent&start=49" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Prime Minister Justin Trudeau making an announcement about applying for the federal dental benefit, at one of Western University’s dental clinics in December 2022.</span></figcaption>
</figure>
<p>Severe gum disease in particular is an inflammatory condition that is linked to several other chronic conditions through <a href="https://doi.org/10.1038/s41577-020-00488-6">exacerbating inflammatory reactions</a> in other organs and body systems and that may arguably contribute to some <a href="https://doi.org/10.1016/j.amjcard.2016.05.036">heart</a> and <a href="https://doi.org/10.1111/nep.13225">kidney diseases</a>, among others.</p>
<p>Importantly, there is <a href="https://doi.org/10.1038/sj.bdj.2017.544">a bidirectional relationship between gum diseases and diabetes</a>, where severe inflammation of the gums and supporting bone can aggravate the risk and complications of diabetes, and vice versa.</p>
<p>The consequences of an unhealthy mouth also extend to an individual’s social interactions. For example, those experiencing poor esthetics due to crooked, broken or stained teeth are more likely to be <a href="https://doi.org/10.1016/j.ssmph.2015.11.001">stigmatized and blamed for their dental appearance</a>. In severe cases, they may potentially have <a href="https://www.thestar.com/news/why-is-he-out-of-work/article_711c362f-333c-5580-97ae-7f4646eb092d.html">fewer opportunities for employment</a>.</p>
<p>Observations such as these bring to mind the 19th century’s French naturalist and father of paleontology, Georges Cuvier who famously said, “<a href="https://wellcomecollection.org/articles/W3LpDykAACgAEVFi">Show me your teeth and I will tell you who you are</a>.” </p>
<p>Cuvier’s statement at the time intended to describe how teeth where distinctive of populations according to diets and environmental impacts. Nevertheless, it is not hard to see its relevance to the appearance and health of the mouth and teeth and their impact on how one is perceived in today’s society.</p>
<h2>Children’s health and dental care</h2>
<figure class="align-center ">
<img alt="A boy being examined. by a dental care worker out of shot" src="https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Canadian kindergarteners in need of dental treatment are found to score lower on physical, cognitive, social and emotional development scales than those without dental problems.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Certainly, oral diseases affect all age groups and children are no exception. Recent reports show that almost <a href="https://iris.who.int/bitstream/handle/10665/373542/9789240070820-eng.pdf?sequence=1">39 per cent of Canadian children</a> under nine years old have dental decay. Just like in adults, the impact of dental decay on children extends to poor nutrition, and affects sleep and development.</p>
<p>For example, Canadian kindergarteners in need of dental treatment were found to <a href="https://doi.org/10.1186/s12887-019-1868-x">score lower on physical, cognitive, social and emotional development scales</a> than those without dental problems. On top of this, researchers found the treatment of severely decayed teeth to be by far <a href="https://publications.gc.ca/collections/collection_2014/icis-cihi/H118-94-2013-eng.pdf">the most common reason for children aged one to five years old to receive general anesthesia to undergo surgery</a>.</p>
<h2>Dental care and chronic conditions</h2>
<p>The connection between oral health and overall health is evident in myriad ways, and so is the need to improve oral health and access to dental care in Canada. It also raises the question of whether dental care can help alleviate chronic conditions beyond the mouth. </p>
<p>The <a href="https://doi.org/10.1038/s41467-022-35337-8">scientific evidence on that varies</a>, and largely depends on the chronic condition in question. For example, patients with diabetes are among those who can benefit the most from having better access to dental care. Treating gum diseases can help subside body inflammation and <a href="https://doi.org/10.1002%2F14651858.CD004714.pub4">reduce the risk and complications of diabetes by helping the body regulate blood glucose levels</a>. </p>
<p>Notably, Canada ranks <a href="https://iris.who.int/bitstream/handle/10665/373542/9789240070820-eng.pdf">fourth out of 29 countries</a> in the Region of the Americas in its rate of lip and oral cavity cancer. Many dentists are trained to spot the signs of oral cancer and can help in its early detection, which can be lifesaving.</p>
<p>As we learn more on the impact of dental treatment on chronic disease management, we know that facilitating access to dental care can have promising results on several fronts. In addition to saving costs for individuals and our health-care system, it would enhance the population’s oral health and potentially help in the management of some chronic diseases, such as diabetes. </p>
<p>Importantly, it can reduce the pervasive and inequitable burden of oral diseases. </p>
<p>Indeed, investing in better access to dental care may bring us closer to a healthy smile and beyond, for every Canadian.</p><img src="https://counter.theconversation.com/content/219878/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Noha Aziz-Ezzat Gomaa receives or has received funding from the Canadian Institutes of Health Research, the Schulich School of Medicine & Dentistry at Western University, and the Children's Health Foundation. She is affiliated with various national and provincial dental professional associations.</span></em></p>In addition to saving costs for individuals and our health-care system, facilitating access to dental care would enhance the population’s oral health and potentially help in managing chronic diseases.Noha A. Gomaa, Assistant Professor, Dental Public Health and Oral Medicine, Schulich School of Medicine & Dentistry, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2139802023-10-29T19:11:25Z2023-10-29T19:11:25ZSlashing salt can save lives – and it won’t hurt your hip pocket or tastebuds<figure><img src="https://images.theconversation.com/files/554200/original/file-20231017-24-k6ygeh.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5447%2C3628&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/salty-snacks-pretzels-chips-crackers-637166818">Shutterstock</a></span></figcaption></figure><p>Each year, more than <a href="https://www.aihw.gov.au/getmedia/eb5fee21-7f05-4be1-8414-8b2bba7b4070/ABDS-2018-Risk-factor-supp-data-tables.xlsx.aspx">2,500 Australians</a> die from diseases linked to eating too much salt. </p>
<p>We shouldn’t be putting up with so much unnecessary illness, mainly from heart disease and strokes, and so many deaths. </p>
<p>As a new <a href="https://grattan.edu.au/report/sneaky-salt/">Grattan Institute report</a> shows, there are practical steps the federal government can take to save lives, reduce health spending and help the economy.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/essays-on-health-how-food-companies-can-sneak-bias-into-scientific-research-65873">Essays on health: how food companies can sneak bias into scientific research</a>
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<h2>We eat too much salt, with deadly consequences</h2>
<p>Eating too much salt is bad for your health. It <a href="https://www.nature.com/articles/s41569-018-0004-1">raises blood pressure</a>, which increases the risk of <a href="https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.119.14240">heart disease and stroke</a>. </p>
<p>About <a href="https://www.aihw.gov.au/reports/risk-factors/high-blood-pressure/contents/summary">one in three</a> Australians has high blood pressure, and eating too much salt is the biggest individual contributor.</p>
<p>Unfortunately, the average Australian eats far too much salt – <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja17.00394">almost double</a> the recommended daily maximum of 5 grams, equivalent to <a href="https://www.heartfoundation.org.au/sodium-and-salt-converter#:%7E:text=We%20recommend%20adults%20eat%20less,about%201%20teaspoon%20a%20day">a teaspoon</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-much-salt-is-ok-to-eat-58594">Health Check: how much salt is OK to eat?</a>
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<p>Australian governments know excessive salt intake is a big problem. That’s why in <a href="https://www.health.gov.au/resources/publications/national-preventive-health-strategy-2021-2030?language=en">2021 they set a target</a> to reduce salt intake by at least 30% by 2030. </p>
<p>It’s an ambitious and worthy goal. But we’re still eating too much salt and we don’t have the policies to change that. </p>
<h2>Most of the salt we eat is added to food during manufacturing</h2>
<p>Most of the salt Australians eat doesn’t come from the shaker on the table. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231587/">About three-quarters</a> of it is added to food during manufacturing. </p>
<p>This salt is hidden in everyday staples such as bread, cheese and processed meats. Common foods such as ready-to-eat pasta meals or a ham sandwich can have up to half our total recommended salt intake. </p>
<h2>Salt limits are the best way to cut salt intake</h2>
<p>Reducing the amount of salt added to food during manufacturing is the most effective way to reduce intake. </p>
<p>Salt limits can help us do that. They work by setting limits on how much salt can be added to different kinds of food, such as bread or biscuits. To meet these limits, companies need to change the recipes of their products, reducing the amount of salt.</p>
<figure class="align-center ">
<img alt="Woman at supermarket compares bread" src="https://images.theconversation.com/files/554201/original/file-20231017-25-bh0m9p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/554201/original/file-20231017-25-bh0m9p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554201/original/file-20231017-25-bh0m9p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554201/original/file-20231017-25-bh0m9p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554201/original/file-20231017-25-bh0m9p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554201/original/file-20231017-25-bh0m9p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554201/original/file-20231017-25-bh0m9p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Food manufacturers can reduce the salt content of their food.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-girl-holding-sliced-white-bread-1891015522">Shutterstock</a></span>
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<p>Under salt limits, the United Kingdom reduced salt intake <a href="https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.16649">by 20% in about a decade</a>. <a href="https://www.nature.com/articles/s41371-021-00653-x">South Africa</a> is making even faster gains. Salt limits are cheap and easy to implement, and can get results quickly.</p>
<p>Most consumers won’t notice a change at the checkout. Companies will need to update their recipes, but even if all the costs of updating recipes were passed on to shoppers, we calculate that at most it would cost about 10 cents each week for the average household. </p>
<p>Nor will consumers notice much of a change at the dinner table. <a href="https://www.mdpi.com/2072-6643/6/10/4354">Most people don’t notice</a> when some salt is removed <a href="https://www.sciencedirect.com/science/article/pii/S0022316622031224">from common foods</a>. There are many ways companies can make foods taste just as salty without adding as much salt. For example, they can make <a href="https://www.wsj.com/articles/SB10001424052748704534904575131602283791566">salt crystals finer</a>, or use <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520464/">potassium-enriched salt</a>, which swaps some of the harmful sodium in salt for potassium. And because the change will be gradual, our tastebuds will <a href="https://doi.org/10.1093/eurjcn/zvac060.077">adapt to less salty foods</a> over time. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-we-may-think-are-the-healthiest-bread-and-wrap-options-actually-have-the-most-salt-74831">What we may think are the healthiest bread and wrap options actually have the most salt</a>
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<h2>Australia’s salt limits are failing</h2>
<p>Australia has had voluntary salt limits since 2009, but they are badly designed, poorly implemented, and have reduced population salt intake by just <a href="https://www.abs.gov.au/articles/healthy-food-partnership-reformulation-program-two-year-progress">0.3%</a>.</p>
<p>Because Australia’s limits are voluntary, many food companies have chosen not to participate in the scheme. Our analysis shows that 73% of eligible food products are not participating, and only 4% have reduced their salt content. </p>
<h2>Action could save lives</h2>
<p>Modelling from the University of Melbourne <a href="https://mspgh.unimelb.edu.au/__data/assets/pdf_file/0004/4783405/The-Health-and-Cost-Impacts-of-Sodium-Reduction-Interventions-in-Australia.pdf">shows</a> that fixing our failed salt limits could add 36,000 extra healthy years of life, across the population, over the next 20 years. </p>
<p>This would delay more than 300 deaths each year and reduce health-care spending by A$35 million annually, the equivalent of 6,000 hospital visits. </p>
<p><a href="https://www.nature.com/articles/jhh2013105">International experience</a> <a href="https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.16649">shows</a> the costs of implementing such salt limits would be very low and far outweighed by the benefits.</p>
<h2>How to fix our failed salt limits</h2>
<p>To achieve these gains, the federal government should start by enforcing the limits we already have, by making compliance mandatory. <a href="https://www.sciencedirect.com/science/article/abs/pii/S216183132300042X">Fifteen countries</a> have mandatory salt limits, and 14 are planning to introduce them.</p>
<p>The number of foods covered by salt limits in Australia should more than double, to be as broad as those the <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/604338/Salt_reduction_targets_for_2017.pdf">UK set in 2014</a>. Broader targets would include common foods for which Australia does not currently set targets, such as baked beans, butter, margarine and canned vegetables. </p>
<p>A loophole in the current scheme that lets companies leave out a fifth of their products should be closed. The federal government should design the policy, rather than doing it jointly with industry representatives.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/concerned-about-your-risk-of-a-heart-attack-here-are-5-ways-to-improve-your-heart-health-178631">Concerned about your risk of a heart attack? Here are 5 ways to improve your heart health</a>
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<p>Over the coming decades, Australia will need many new and improved policies to reduce diet-related disease. Reducing salt intake must be part of this agenda. For too long, Australia has let the food industry set the standard, with almost no progress against a major threat to our health. </p>
<p>Getting serious about salt would save lives, and it would more than pay for itself through reduced health-care costs and increased economic activity.</p><img src="https://counter.theconversation.com/content/213980/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Breadon's employer, Grattan Institute, has been supported in its work by government, corporates, and philanthropic gifts. A full list of supporting organisations is published at <a href="http://www.grattan.edu.au">www.grattan.edu.au</a>.</span></em></p><p class="fine-print"><em><span>Lachlan Fox's employer, Grattan Institute, has been supported in its work by government, corporates, and philanthropic gifts. A full list of supporting organisations is published at <a href="http://www.grattan.edu.au">www.grattan.edu.au</a>.</span></em></p>Eating too much salt is bad for our health. Governments and food manufacturers have a big role to play in reducing the salt content of Australians’ diets.Peter Breadon, Program Director, Health and Aged Care, Grattan InstituteLachlan Fox, Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2068112023-08-31T08:22:58Z2023-08-31T08:22:58ZFrom menstrual leave to chronic illnesses: what if workplaces were kinder to our bodies?<figure><img src="https://images.theconversation.com/files/545224/original/file-20230829-15-cdhi8y.jpeg?ixlib=rb-1.1.0&rect=25%2C0%2C1888%2C1276&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In 2021, more than one third of people in the EU reported from a long-standing health issue. </span> <span class="attribution"><a class="source" href="https://www.pexels.com/fr-fr/photo/femme-appuyee-sur-la-table-3767411/">Andrea Piacquadio/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>With schools due to reopen soon, many of us will also be returning to work after the summer holidays. For those suffering from health issues especially, the past weeks will have provided a well-needed break from the daily grind, or what the French would colourfully refer to <em>métro-boulot-dodo</em> (metro-work-sleep). </p>
<p>That chronological straitjacket may be in the process of being loosened, however. Some of the world’s biggest companies, Google included, are <a href="https://www.jumpstartmag.com/5-companies-that-let-you-take-power-naps-at-work/">now offering sleep pods</a> to help with workers’ sleep issues, while Spain passed a law this year allowing women suffering from severe period to take <a href="https://www.euronews.com/next/2023/02/16/spain-set-to-become-the-first-european-country-to-introduce-a-3-day-menstrual-leave-for-wo">menstrual leave</a>. Increasingly, corporations are also taking measures to accommodate employees with different neurological profiles. So, are timetables and workplaces based on our individual biologies the way forward?</p>
<h2>Considering biological factors</h2>
<p>That interrogation arose five years ago, when I was pregnant. I experienced a chronic condition myself and tried to adjust in my work as a professor at a school of management. As an expert in work and employment practices in the workplace, I knew companies may offer flexible work arrangement to accommodate the social life of their employees. But what about their health?</p>
<p>Before turning to that question, we could do well with identifying <em>how</em> our bodies differ from one another. Looking at current research from various scientific disciplines, it is possible to distinguish between three broad biological conditions that have repercussions on people’s ability to work:</p>
<ul>
<li><p><strong>Chronic illnesses</strong>. Common debilitating conditions include diabetes, cancers, mental illnesses as well as lung, gastrointestinal and cardiovascular diseases. In 2021, <a href="https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Self-perceived_health_statistics&oldid=509628">more than one third (35.2%) of people in the EU</a>) reported suffering from a long-standing health problem. Women are particularly exposed through their biological cycles including periods, pregnancy and menopause.</p></li>
<li><p><strong>Neurodiversity</strong>. Not all brains pan out the same way. Some go on to develop autism, Down syndrome, attention deficit disorder with or without hyperactivity, dyslexia, dyspraxia and other conditions beginning with <em>dy</em>. Like chronic illnesses, neurodevelopmental differences affect a significant sample of the population, with <a href="https://www.ameli.fr/medecin/exercice-liberal/prise-charge-situation-type-soin/troubles-neurodeveloppement-autisme">one in ten people in the world impacted</a>.</p></li>
<li><p><strong>Circadian rhythms</strong>. Far from a myth, the reality of early birds and night owls has long been backed by science. <a href="https://www.sciencedirect.com/science/article/pii/S0013700609755344">Research</a> shows that health predispositions mean our most productive hours vary from one individual to another. Going against one’s rhythm can upset sleep, metabolism as well as cardiovascular and immune systems.</p></li>
</ul>
<h2>Band-aid solutions</h2>
<p>While <a href="https://www.lemonde.fr/emploi/article/2023/05/29/la-qualite-de-l-emploi-et-du-travail-en-comparaison-europeenne-une-contre-performance-francaise_6175274_1698637.html">33% of European workers</a> say that their health is at risk because of their employment activity, arrangements to accommodate our bodies are lacklustre at best. Although remote working is often thought to empower employees to manage their health more effectively, we also now know that it can act as a double-edged sword by undermining their <a href="https://theconversation.com/why-workers-in-small-businesses-can-struggle-with-mental-health-and-presenteeism-208877">right to disconnect</a>.</p>
<p>More formal solutions are also riddled with shortcomings. In France, where I come from, an employee struggling with chronic health issues or a neurodiverse condition can apply for the status of disabled worker, which is conferred following a medical examination. The label then compels the workplace to accommodate the employee – for example, by providing a flexible schedule to a worker suffering from severe insomnia, an adapted desk for another suffering from a spinal injury, or by excluding the employee from particular types of activities.</p>
<p>That’s for the theory. In practice, workers are often reluctant to apply, partly due to the procedure’s medical complexity and cost, which is not covered by the national health insurance. Too often, the status also carries too heavy a stigma, with many opting out for reasons of pride. Finally, there is a real chance that companies, particularly small business, will not be able to accommodate the employee’s demands, and therefore lay them off for ineptitude.</p>
<p>For want of a medical diagnosis, certain employers may negotiate special employment terms with some employees. This is what is known in management literature as <a href="https://www.jstor.org/stable/20159261">“i-deals”</a>. For instance, work schedules or remuneration can be defined according to the employee’s preferences. The problem is that this solution hinges on the bargaining power they have over their employer. Hence, so-called key employees may get what they want by contrast with employees who are seen as underperforming.</p>
<p>To my knowledge, no government has yet thought out work policies to optimise our respective circadian rhythms. Rather, their focus is on limiting the damage of night- and shift work. While we could imagine to allocate early or late shifts to individuals whose metabolisms are better suited to it, the practices are not based on chronotype diversity. Instead, a growing number of companies offer the possibility of flexible working to their employees on the condition that they fulfil their obligations.</p>
<h2>When teamwork takes the hit</h2>
<p>Inevitably, such arrangements come at the cost of <a href="https://www.cairn.info/les-grands-courants-gestion-ressources-humaines--9782376874638-page-199.htm">the company’s teamwork and collective productivity</a>. Indeed, how can one possibly go about juggling the needs of a person working from home due to chronic pain, with those of another who comes in at midday while colleagues are there by 9 a.m.? And that’s without forgetting that colleague’s exemption from using certain work tools due to their neurodiversity.</p>
<p>Not to mention that managers in charge of overseeing these arrangements have their own health issues to contend with. Nearly half of French managers (48%) report that they are stressed at work. They are over-represented in terms of sick leave, and have scored <a href="https://newsroom.malakoffhumanis.com/actualites/avec-plus-de-40-de-salaries-arretes-chaque-annee-labsenteisme-maladie-reste-un-probleme-majeur-2f9e-63a59.html">2 to 5 percentage points higher than the employee average since 2018</a>. Nearly a quarter of managerial staff (24%) report using sleeping pills or anti-depressants compared to 18% of employees.</p>
<h2>Retraining managers</h2>
<p>In April, the French government released a report, <a href="https://travail-emploi.gouv.fr/IMG/pdf/assises_du_travail_-_rapport_des_garants.pdf">“Rethinking work”</a>, aimed at sparking a debate with trade unions on these questions. It found that transforming managerial practices will be essential if companies are to “[give] employees more responsibility, autonomy and recognition” and calls for a shift from a “culture of control to a culture of trust”. Recommendations include training to raise managers’ awareness over possible health issues. The idea is to create and maintain a <a href="https://www.ips-journal.eu/work-and-digitalisation/improving-working-life-in-france-and-the-eu-6858/">culture of risk prevention</a> in work situations.</p>
<p>On the one hand, raising managers’ awareness of health issues has shown some promise. For example, research on the retention of employees suffering from <a href="https://www.ameli.fr/rhone/assure/sante/themes/polyarthrite-rhumatoide/comprendre-polyarthrite-rhumatoide">rheumatoid arthritis</a> showed the <a href="https://www.tandfonline.com/doi/full/10.1080/09585192.2020.1737175">importance of managers having knowledge or personal experience of the disability</a> in terms of introducing policies that would be beneficial to both employee and employer.</p>
<p>If that approach is to be successful, managers will also need to <a href="https://www.hbrfrance.fr/chroniques-experts/2016/06/11208-comment-manager-sans-sepuiser/">abandon the idea of being the perfect supervisor and accepting their limits</a>.</p>
<h2>Collective, not individual solutions</h2>
<p>But training managers anew is hardly a silver bullet. For one, it still results in an uncoordinated organisation. Moreover, when I reviewed the <a href="https://www.cairn.info/les-grands-courants-gestion-ressources-humaines--9782376874638-page-199.htm">past 40 years of research on flexibility practices</a> in 2021, I found that companies’ organisation suffered biggest setbacks when they tailored work arrangements for specific individuals rather than for the collective of workers. </p>
<p>Looking away from a frazzled patchwork of individual solutions, an increasing number of companies and governments are contemplating organisational shifts benefiting all, including in terms of working days. In February 2023, Belgium became the first country to legislate to enable employees to choose to work four-day weeks if they want it, providing they worked the same hours as in a day-week. Others are <a href="https://www.euronews.com/next/2023/06/21/the-four-day-week-which-countries-have-embraced-it-and-how-s-it-going-so-far">also following suit</a>, with trials having taken place or about to take place in Spain, Portugal, Sweden, Iceland, Germany and the United Kingdom. The latter was the object of a scientific study with <a href="https://podcast.ausha.co/explorhation/semaine-de-4-jours-marie-rachel-jacob">results</a> showing that British companies have been able to transition to four-day weeks (with reduction in working-week hours) without losing productivity.</p>
<p>Placing the onus on the organisation of the whole company, or even country, has the merit of protecting team work, while also liberating time for caregivers. It can also prevent envy toward what can be perceived as the <a href="https://www.forbes.com/sites/andrewpulrang/2023/01/25/4-ways-people-with-disabilities-can-have-privilege-too/?sh=498f6ec87f3a">material privileges</a> of those living with a condition. After all, <a href="https://www.europe1.fr/economie/La-grande-histoire-des-allocations-de-la-Liberation-a-aujourd-hui-681878">this is the same logic</a> that drove French politicians in 1945 to vote for the same family allowances to be distributed based on the number of children, regardless of income; if all citizens benefited from the welfare state, then support for it would be stronger, or so the left and right argued at the time.</p>
<p>Most will agree that those living with chronic illness, neurodiversity or/and different circadian rhythms deserve our full support.</p><img src="https://counter.theconversation.com/content/206811/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie-Rachel Jacob ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>Should companies offer tailored timetables and workplaces on the basis of our different bodies, or are universal solutions, such as the four-day week, the way forward?Marie-Rachel Jacob, Professeur-chercheur en management, EM Lyon Business SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2064022023-07-25T01:26:05Z2023-07-25T01:26:05ZHow burgers and chips for lunch can worsen your asthma that afternoon<figure><img src="https://images.theconversation.com/files/534504/original/file-20230628-15-3dpvk3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C998%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/delicious-burger-chips-handmade-house-on-243618775">Shutterstock</a></span></figcaption></figure><p>Certain foods or dietary patterns are linked with better control of your asthma. Others may make it worse. Depending on what you’ve eaten, you can see the effects in hours.</p>
<p>Food can affect how well your lungs function, how often you have asthma attacks and how well your puffer works.</p>
<p>Here’s what we know about which foods to eat more of, and which are best to eat in smaller amounts, if you have asthma.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-asthma-what-we-know-dont-know-and-suspect-96409">What causes asthma? What we know, don't know and suspect</a>
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<h2>Asthma and inflammation</h2>
<p>About <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/asthma/latest-release">one in ten</a> Australians (2.7 million people) have asthma. This makes it the <a href="https://www.health.gov.au/topics/chronic-conditions/chronic-conditions-in-australia">fourth</a> most common chronic (persisting) disease in Australia. </p>
<p><a href="https://www.nationalasthma.org.au/understanding-asthma/what-is-asthma">Asthma</a> is an inflammatory disease. When someone is exposed to certain triggers (such as respiratory viruses, dust or exercise), the airways leading to the lungs become inflamed and narrow. This makes it difficult for them to breathe during what’s commonly known as an asthma attack (or exacerbation).</p>
<p>Researchers are becoming increasingly aware of how someone’s diet can affect their asthma symptoms, including how often they have one of these attacks.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/passive-smoking-synthetic-bedding-and-gas-heating-in-homes-show-the-strongest-links-to-asthma-176677">Passive smoking, synthetic bedding and gas heating in homes show the strongest links to asthma</a>
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<h2>Thumbs up for fruit and veg</h2>
<p>The Mediterranean diet – a diet high in fruit, vegetables and oily fish – is linked with <a href="https://pubmed.ncbi.nlm.nih.gov/30997754/">less wheezing</a> in children, whether or not they have been diagnosed with asthma. Some, but not all, of the studies found this was regardless of the children’s body-mass index (BMI) or socioeconomic status.</p>
<p>Eating a diet high in fruits and vegetables is also important for adults with asthma. Two studies found adults who were instructed to eat a diet with few fruits and vegetables (two or fewer servings of vegetables, and one serving of fruit daily) had <a href="https://pubmed.ncbi.nlm.nih.gov/18324527/">worse lung function</a> and were twice as likely to have an <a href="https://pubmed.ncbi.nlm.nih.gov/22854412/">asthma attack</a> compared to those eating a diet high in fruits and vegetables. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/534507/original/file-20230628-23-j6h1ll.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Mediterranean diet pyramid" src="https://images.theconversation.com/files/534507/original/file-20230628-23-j6h1ll.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534507/original/file-20230628-23-j6h1ll.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=514&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534507/original/file-20230628-23-j6h1ll.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=514&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534507/original/file-20230628-23-j6h1ll.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=514&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534507/original/file-20230628-23-j6h1ll.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=646&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534507/original/file-20230628-23-j6h1ll.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=646&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534507/original/file-20230628-23-j6h1ll.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=646&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The Mediterranean diet is rich in antioxidants and soluble fibre.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/illustration-mediterranean-diet-meal-shape-food-1640001031">Shutterstock</a></span>
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<p>Why might the Mediterranean diet, or one rich in fruit and vegetables, help? Researchers think it’s because people are eating more antioxidants and soluble fibre, both of which have anti-inflammatory action: </p>
<ul>
<li><p><strong>antioxidants</strong> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075620/">neutralise free radicals</a>. These are the damaging molecules produced as a result of inflammation, which can ultimately cause more inflammation</p></li>
<li><p><strong>soluble fibre</strong> is fermented by gut bacteria to produce short-chain fatty acids such as acetate, propionate and butyrate, which <a href="https://www.sciencedirect.com/science/article/pii/S2352385919300246">reduce inflammation</a>. </p></li>
</ul>
<p>The Mediterranean diet is also high in omega-3 fatty acids (from oily fish, such as salmon, mackerel and tuna). However a <a href="https://www.mdpi.com/2072-6643/12/12/3839">review</a> looked at five studies that investigated omega-3 intake (through the diet or with a supplement) in adults with asthma. None of the studies showed any benefit associated with omega-3 for asthma.</p>
<p>Of course there is no harm in eating foods high in omega-3 – such as oily fish, flaxseeds, chia seeds and walnuts. This has numerous other benefits, such as <a href="https://pubmed.ncbi.nlm.nih.gov/29350557/">lowering the risk</a> of heart disease. </p>
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Read more:
<a href="https://theconversation.com/food-as-medicine-how-what-you-eat-shapes-the-health-of-your-lungs-73450">Food as medicine: how what you eat shapes the health of your lungs</a>
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<h2>Thumbs down for saturated fat, sugar, red meat</h2>
<p>Saturated fats are found in highly processed foods such as biscuits, sausages, pastries and chocolate, and in fast foods. </p>
<p>Diets high in saturated fats, plus sugar and red meat, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888803/">can worsen</a> someone’s asthma symptoms.</p>
<p>For instance, one study found a diet high in these foods increased the number of <a href="https://pubmed.ncbi.nlm.nih.gov/18829673/">asthma attacks</a> in adults.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/534506/original/file-20230628-21-6oihd1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman clutching throat reaching for asthma inhaler on table" src="https://images.theconversation.com/files/534506/original/file-20230628-21-6oihd1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534506/original/file-20230628-21-6oihd1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=380&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534506/original/file-20230628-21-6oihd1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=380&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534506/original/file-20230628-21-6oihd1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=380&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534506/original/file-20230628-21-6oihd1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=477&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534506/original/file-20230628-21-6oihd1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=477&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534506/original/file-20230628-21-6oihd1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=477&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">What you eat can affect how well your asthma puffer works.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asthma-attack-young-woman-reaching-inhaler-1554476906">Shutterstock</a></span>
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<p>Foods high in saturated fat can have an impact in as little as <a href="https://pubmed.ncbi.nlm.nih.gov/21377715/">four hours</a>. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/21377715/">One study</a> looked at what happened when adults with asthma ate a meal high in saturated fat (consisting of two hash browns, a sausage and egg muffin, and a sausage muffin) compared with a meal with similar calories but low in saturated fat.</p>
<p>People who ate the meal high in saturated fat had reduced lung function within four hours. Within four hours, their puffer was also less effective.</p>
<p>These worsening symptoms were likely driven by an increase in inflammation. Around the four hour mark, researchers found an increase in the number of the immune cells known as neutrophils, which play a role in inflammation.</p>
<p>It’s still OK to eat a sneaky burger or some hot chips occasionally if you have asthma. But knowing that eating too many of these foods can affect your asthma can help you make choices that might improve your quality of life.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/clear-evidence-for-a-link-between-pro-inflammatory-diets-and-27-chronic-diseases-heres-how-you-can-eat-better-158451">Clear evidence for a link between pro-inflammatory diets and 27 chronic diseases. Here’s how you can eat better</a>
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<h2>What about dairy?</h2>
<p>One food type you don’t have to avoid, though, is <a href="https://theconversation.com/mondays-medical-myth-dairy-products-exacerbate-asthma-10641">dairy products</a>. </p>
<p>Although many people with asthma report eating dairy worsens their asthma, evidence shows this to be untrue. In fact, one study in adults with asthma found drinking milk was linked to <a href="https://pubmed.ncbi.nlm.nih.gov/33918391/">better</a> lung function.</p>
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<em>
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Read more:
<a href="https://theconversation.com/mondays-medical-myth-dairy-products-exacerbate-asthma-10641">Monday's medical myth: dairy products exacerbate asthma</a>
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<img src="https://counter.theconversation.com/content/206402/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evan Williams receives funding from The John Hunter Charitable Trust Foundation. </span></em></p>Some foods can affect how well your lungs function, how often you have asthma attacks and how well your puffer works. Here’s what to eat if you have asthma.Evan Williams, Postdoctoral Researcher in Respiratory and Nutritional Biochemistry, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2052782023-05-17T18:04:19Z2023-05-17T18:04:19ZMAID’s evolving ethical tensions: Does it make dying with dignity easier than living with dignity?<figure><img src="https://images.theconversation.com/files/526437/original/file-20230516-17-xndwxx.jpg?ixlib=rb-1.1.0&rect=127%2C82%2C4446%2C3016&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There is debate about whether a health-care worker can ethically participate in both palliative care and the MAID program. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Medical assistance in dying (MAID) has <a href="https://doi.org/10.1007/s10912-022-09764-z">received lots of media attention over the past few years</a>. This is especially true as the Canadian government considers expanding eligibility for people whose sole underlying condition is a mental illness. This has led to <a href="https://theconversation.com/canada-delays-expanding-medical-assistance-in-dying-to-include-mental-illness-but-its-still-a-policy-built-on-quicksand-196264">increased concerns about the ethics of MAID</a>.</p>
<p>Even in its present form, MAID is fraught with ethical tensions. As scholars <a href="https://doi.org/10.1016/j.jrurstud.2022.09.011">engaged in research on MAID</a>, we have heard about these tensions firsthand through interviews with physicians and nurses who provide MAID-related care, clinical ethicists who perform MAID-related consults, family members of patients who have received MAID and patients who have requested MAID. </p>
<p>From these conversations, we highlight three emerging tensions: </p>
<ol>
<li>Palliative care versus MAID provision; </li>
<li>Transparency versus privacy; and </li>
<li>Providing a dignified death versus a dignified life. </li>
</ol>
<p>These tensions can contribute to unpredictability in health service provision, strained relationships, moral distress, harm for prospective patients and the erosion of public trust.</p>
<h2>Palliative care vs. MAID provision</h2>
<p>There is debate about whether a health-care worker can participate in both palliative care and the MAID program. </p>
<p>Palliative care involves efforts to improve the <a href="https://www.virtualhospice.ca/Assets/MAiD_Report_Final_October_15_2018_20181218165246.pdf">quality of life of patients facing serious or life-threatening illness by preventing or relieving suffering through early identification, assessment and treatment of pain, including physical, psychosocial and spiritual pain</a>. MAID, on the other hand, provides patients experiencing intolerable suffering the option to end their lives with the assistance of a doctor or nurse practitioner.</p>
<p>Some people see the two services as <a href="https://healthydebate.ca/2020/06/topic/palliative-care-and-maid/">co-existing within end-of-life care</a>. Others view them as having <a href="https://www.chpca.ca/news/chpca-and-cspcp-joint-call-to-action/">incompatible intentions and goals</a>, and may see the two services as being in conflict. </p>
<figure class="align-center ">
<img alt="A man in a white coat, stethoscope and face mask sitting in a chair and looking upset" src="https://images.theconversation.com/files/526440/original/file-20230516-23-z7vmtt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526440/original/file-20230516-23-z7vmtt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526440/original/file-20230516-23-z7vmtt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526440/original/file-20230516-23-z7vmtt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526440/original/file-20230516-23-z7vmtt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526440/original/file-20230516-23-z7vmtt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526440/original/file-20230516-23-z7vmtt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ethical conflicts can potentially place strain on professional relationships between MAID providers and palliative care teams or cause moral distress for palliative care providers.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>For instance, as one medical professional informed us, pharmaceuticals that might be provided to relieve pain during palliative care could undermine cognitive capacity and limit a patient’s ability to provide consent to MAID:</p>
<blockquote>
<p>“It was brutal. I knew at that time we wouldn’t be able to do the provision because we would have to medicate her so much… then we’d have to reverse it to get consent, and that was really hard.”</p>
</blockquote>
<p>Examples like this reveal the tensions that medical professionals might face if they seek to provide both palliative care and MAID. We also heard that some palliative care professionals perceive MAID requests as a failure of their efforts to provide quality palliative care. </p>
<p>This can potentially place strain on professional relationships between MAID providers and palliative care teams, or cause moral distress for palliative care providers.</p>
<h2>Transparency vs. privacy</h2>
<p>The federal government notes the importance of <a href="https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html">transparency for the improvement of MAID and maintenance of public trust</a>. However, patients and care providers sometimes have strict privacy concerns, wanting their participation in MAID kept confidential because of disapproving family, colleagues or community members. </p>
<figure class="align-center ">
<img alt="A man in a hospital bed and a woman with her arm around him, both looking at a man in a white coat seen from behind" src="https://images.theconversation.com/files/526438/original/file-20230516-29-52pib8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526438/original/file-20230516-29-52pib8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526438/original/file-20230516-29-52pib8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526438/original/file-20230516-29-52pib8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526438/original/file-20230516-29-52pib8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526438/original/file-20230516-29-52pib8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526438/original/file-20230516-29-52pib8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Patients and care providers sometimes have strict privacy concerns, wanting their participation in MAID kept confidential because of disapproving family, colleagues or community members.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This is particularly true in smaller communities where privacy may be more limited, health-care professionals are <a href="https://doi.org/10.1111/nin.12308">highly visible</a> and people may be concerned about <a href="https://edmontonjournal.com/news/local-news/rural-alberta-faces-more-end-of-life-care-challenges-conference">MAID-related stigma</a>.</p>
<p>One patient in our study had family members insist on keeping their cause of death a secret. Another participant spoke about a patient’s request for the MAID team to do the provision at a long-term care home without letting the staff, family or other residents know. </p>
<p>When medical providers are asked to assist patients in such secrecy, transparency may become compromised.</p>
<blockquote>
<p>“Staff had to really balance transparency with confidentiality… One of those transparency pieces, very clearly from the government, was accurate recording, so that there was nothing secret… (But) we’ve had patients who have said, ‘I don’t want my family to know.’ But they’re going to find out what the cause of death was; the death certificate is very clear.”</p>
</blockquote>
<p>In cases like this, medical professionals are placed in the difficult position of not being able to accommodate privacy requests of patients or family members, as doing so could undermine ethical obligations of transparency and professional accountability.</p>
<h2>A dignified death vs. a dignified life</h2>
<p>MAID is often celebrated for supporting <a href="https://www.dyingwithdignity.ca/">suffering patients to exercise control and die with dignity</a>. </p>
<p>With the passage of <a href="https://www.justice.gc.ca/eng/csj-sjc/pl/charter-charte/c7.html">Bill C-7</a>, which removed the requirement of a reasonably foreseeable death, Canadians are now applying for MAID when suffering is impacted by socioeconomic factors such as inadequate housing, medical care, food security or income supports. </p>
<p>As a result, there has been growing concern about offering this service in a limited social welfare state <a href="https://www.thestar.com/opinion/contributors/2021/02/11/if-medically-assisted-death-becomes-more-accessible-for-canadians-we-have-a-moral-obligation-to-make-living-well-through-housing-mental-health-supports-accessible-too.html?rf">that does not provide the conditions for people with an illness or disability to live with dignity</a>.</p>
<p>There have been news reports of people being offered MAID when they just needed assistance to live. This has included a <a href="https://www.ctvnews.ca/politics/paralympian-trying-to-get-wheelchair-ramp-says-veterans-affairs-employee-offered-her-assisted-dying-1.6179325">veteran who merely required a wheelchair ramp</a>, individuals who did not have access to food or <a href="https://www.ctvnews.ca/health/woman-with-chemical-sensitivities-chose-medically-assisted-death-after-failed-bid-to-get-better-housing-1.5860579">adequate housing</a> and <a href="https://www.ctvnews.ca/health/the-solution-is-assisted-life-offered-death-terminally-ill-ont-man-files-lawsuit-1.3845190">patients who needed home care</a>. </p>
<p>We have also recently seen <a href="https://www.ctvnews.ca/health/the-number-of-medically-assisted-deaths-in-canada-s-prisons-a-concern-for-some-experts-1.6380440">reports of prisoners who may be requesting MAID to escape the harsh conditions of prison life</a>.</p>
<p>In our research, a participant told us about an individual who had received MAID and might have otherwise benefited from existing programs:</p>
<blockquote>
<p>“There was a (patient) in our community who went through MAID… and his diagnosis was heart failure… (But) he never came to our program and I felt there were a lot of things that we can actually do with these heart failure patients to give them good quality of life.”</p>
</blockquote>
<p>Canadian legal scholar Trudo Lemmens has similarly noted <a href="https://www.cbc.ca/news/opinion/opinion-medical-assistance-in-dying-maid-legislation-1.5790710">that MAID may be quicker to access than certain medical and financial supports</a>, including, for instance, access to specialized long-term care, specialized pain clinics and the <a href="https://www.canada.ca/en/services/benefits/publicpensions/cpp/cpp-disability-benefit.html">Canada Pension Plan Disability Benefits</a>.</p>
<p>“It is crucial that individuals are not placed in a position <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349713/">where MAID will be seen as the only alternative to suffering</a>.</p>
<p>Unfortunately, we heard from study participants that this issue may be further exacerbated in rural areas with limited access to palliative care. </p>
<blockquote>
<p>"I think some of those patients don’t get the same palliative care that somebody in town would and so maybe they’re opting to do MAID sooner than somebody else would… maybe they didn’t really want to do it but they kind of felt that it was their only option.”</p>
</blockquote>
<p>Another study has already corroborated this concern, noting there is an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8302435/">inadequate provision of palliative care for those requesting MAID</a>. This is alarming as it signals the reality that MAID requests are sometimes made not out of necessity, but rather due to unmet needs.</p>
<h2>Moving forward</h2>
<p>These tensions surrounding MAID place staff in complex ethical predicaments and are deserving of greater attention. Current policy and legislation do not adequately address how they ought to navigate potential conflicts between palliative care and MAID, between transparency and privacy, or how to best handle MAID requests being made due to unmet socioeconomic or medical needs. </p>
<p>This situation is made worse by the fact that some of our participants felt ill-prepared to step into a MAID-related role due to limited training or support.</p>
<p>We encourage the federal government to reconsider its role in improving the quality of life of its citizens. In many situations, Bill C-7 has made “dying with dignity” easier than “living with dignity.” It is ethically problematic if a state is more willing to facilitate death than to provide the necessities of life.</p><img src="https://counter.theconversation.com/content/205278/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julia Brassolotto receives funding from Alberta Innovates and the Social Sciences and Humanities Research Council (SSHRC). </span></em></p><p class="fine-print"><em><span>Alessandro Manduca-Barone and Monique Sedgwick do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Bill C-7 has created ethical tensions between MAID providers and palliative care, between transparency and patient privacy, and between offering a dignified death rather than a dignified life.Alessandro Manduca-Barone, Research Associate - Faculty of Health Sciences, University of LethbridgeJulia Brassolotto, Associate Professor, Public Health and Alberta Innovates Research Chair, University of LethbridgeMonique Sedgwick, Associate Professor of Nursing, University of LethbridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2041082023-05-11T20:48:13Z2023-05-11T20:48:13ZOlder people who are homeless need better access to hospice and palliative care<figure><img src="https://images.theconversation.com/files/524435/original/file-20230504-15-gf7bsb.jpg?ixlib=rb-1.1.0&rect=149%2C86%2C3000%2C2048&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A core focus of palliative care is on easing symptoms and increasing quality of life for people who have a serious or chronic illness, and not solely for those who are dying.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Most people may not wish to devote much time to thinking about their death. However, it’s an unfortunate fact that the entry point into experiences or conversations around death and end-of-life care can happen abruptly. </p>
<p>An unexpected death or a terminal diagnosis can leave people ill-equipped to navigate what often feels like uncharted territory of navigating end-of-life care, bereavement and grief. </p>
<p>The challenging realities surrounding end-of-life care are especially difficult for older people experiencing homelessness. For these older adults, intersectional and compounding experiences of oppression, such as poverty, racial disparities and ageism, create barriers to accessing hospice care. </p>
<h2>Misconceptions about hospice care</h2>
<p>The need for end-of-life and palliative services for unhoused people will <a href="https://homelesshub.ca/sites/default/files/SOHC16_final_20Oct2016.pdf">likely continue to grow</a> as the population experiencing homelessness grows and ages. </p>
<p>Currently only 16 to 30 per cent of Canadians <a href="https://maisonstraphael.org/wp-content/uploads/2016/05/Fact_Sheet_HPC_in_Canada-Spring-2014-Final.pdf">have access to hospice and palliative care services</a>, and 34 per cent of Canadians are not clear on <a href="http://www.hpcintegration.ca/resources/what-canadians-say/survey-data-by-province.aspx">who is eligible or who should utilize hospice services</a>. In response, May 7-13 marks <a href="https://www.chpca.ca/campaigns/national-hospice-palliative-care-week/">National Hospice Palliative Care week</a>, which is aimed at increasing awareness about hospice care in Canada. </p>
<figure class="align-center ">
<img alt="senior man sitting in chair and talking with a health-care provider wearing scrubs and a stethoscope" src="https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524436/original/file-20230504-25-jg5f4w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hospice care is provided in a number of settings, including in patients’ homes.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The misconceptions about hospice care have had a direct impact on the engagement of services for the public, <a href="https://doi.org/10.1186%2Fs12904-019-0404-y">but also for Indigenous communities and for older adults experiencing homelessness</a>. </p>
<p>Efforts to increase awareness about hospice often neglect the most vulnerable populations. Future efforts must merge education and awareness with intersectionality, which takes into consideration the intersections of inequities that impact unhoused older adults.</p>
<p><a href="https://www.chpca.ca/about-hpc/">Hospice care</a> focuses on addressing the full spectrum of a patient’s physical, emotional, social and spiritual experiences and needs. A common misconception is that hospice is exclusively a location or place where people go to die. Contrary to this notion, hospice is a service that is provided in various settings including within one’s home, long-term care facilities, hospice centres or within a hospital. </p>
<h2>End-of-life care</h2>
<p>While many Canadians <a href="https://maisonstraphael.org/wp-content/uploads/2016/05/Fact_Sheet_HPC_in_Canada-Spring-2014-Final.pdf">prefer to die at home</a>, older people experiencing homelessness <a href="https://doi.org/10.1186/s12904-018-0320-6">do not have the same opportunities for end-of-life care options</a>, and as a result <a href="https://news.gov.bc.ca/releases/2022PSSG0063-001528">many unhoused older people die in the hospital or institutional settings</a>.</p>
<p>Family and friends often play an essential role in caring and advocating for a loved one during their end-of-life process. We can only hope to have loved ones by our side during these final stages; however, that is not the reality for many unhoused community members who do not have the option to die at home with loved ones. </p>
<p><a href="https://doi.org/10.1186/s12904-018-0320-6">Older people experiencing homelessness are especially vulnerable</a> due to limited family or social support networks. Lack of social support can result in unhoused older people feeling isolated and fearful about dying alone or anonymously.</p>
<p>A core focus of palliative care is on <a href="https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care">easing symptoms and increasing quality of life</a> for people who have a serious or chronic illness, and not solely for those who are dying. Palliative care can be a valuable form of health care for older people experiencing homelessness, as it can offer a tailored approach to managing multiple chronic or terminal illnesses, <a href="https://doi.org/10.1016/j.jpainsymman.2016.10.364">which are prevalent among unhoused older people</a>. </p>
<p>Palliative care that takes place in a hospital setting can decrease end-of-life care costs by nearly 50 per cent <a href="http://hpcintegration.ca/media/24434/TWF-Economics-report-Final.pdf">by reducing intensive care unit admissions and unnecessary intervention procedures</a>. </p>
<p>We believe it is valuable to consider that if end-of-life care costs were reduced by using palliative care practices, the cost savings could be used to fund services that directly support unhoused older adults, such as increased affordable housing options. </p>
<h2>Aging in the right place</h2>
<p>As members of the <a href="https://www.sfu.ca/airp.html">Aging in the Right Place</a> project research team at Simon Fraser University, we are working to better understand what aging and dying in the right place means to unhoused older adults in two sites providing end-of-life care in Vancouver. </p>
<p>May’s Place Hospice, which is in the Downtown Eastside of Vancouver, provides end-of-life care for community members in that part of the city. May’s Place has created a communal, home-like environment with private rooms, meals provided three times a day, 24-hour nursing care, a smoking lounge and family gathering space. </p>
<figure class="align-center ">
<img alt="A person in a hospital bed looking out a large window with a mug in their hands." src="https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524438/original/file-20230504-25-zj240g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Palliative care that takes place in a hospital setting can decrease end-of-life care costs by nearly 50 per cent.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Another inpatient hospice setting in Vancouver is Cottage Hospice, located in a 1924 heritage building. Patients have a view of the North Shore mountains and are close to the water. Cottage Hospice and May’s place provide the same types of hospice palliative care support, and both care for older patients experiencing homelessness, but serve different populations based on their location and setting, demonstrating that hospice and palliative care is not a one-size-fits all approach.</p>
<p>The Aging in the Right Place project captures the perspectives and lived experiences of older people experiencing homelessness through integrating photovoice interview research methods as well as data collection methods that focused on the hospice setting, the neighbourhood, and experiences of staff who work to support unhoused older people. <a href="https://doi.org/10.1177/109019819702400309">Photovoice is a method used in community-based research</a> in which participants use photo taking and storytelling to document their own perspectives and experiences.</p>
<p>In the Vancouver area where we work — also known as the land that belongs to the Skwxwú7mesh (Squamish), xʷməθkwəy̓əm (Musqueam) and Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh) people — and throughout the province, <a href="https://doi.org/10.1186/s12904-019-0404-y">colonization and colonial medical models have had lasting and detrimental impacts</a> on Indigenous knowledge and traditional practices around death and dying for First Nation communities.</p>
<p>One example of these impacts is that current hospice models may not reflect culturally relevant care models. Hospice organizations throughout B.C. should prioritize increasing policy and practice for Indigenous groups to ensure safety and culturally relevant care are implemented. Ensuring accessibility to hospice and palliative care is one step towards dismantling these barriers for Indigenous populations. </p>
<p>B.C. can turn to the <a href="https://www.icha-toronto.ca/programs/peach-palliative-education-and-care-for-the-homeless">Palliative Education and Care for the Homeless (PEACH) service fostered by Inner City Health Associates (ICHA)</a> in Toronto as an example. PEACH is taking a diverse and innovative approach to providing palliative care among the homeless and vulnerable populations, including Indigenous communities and older adults. Innovative and culturally sensitive services such as these, are a step in the right direction to providing better end-of-life care to older adults experiencing homelessness.</p>
<p>It is crucial that we make hospice and palliative care services available to all community members, especially with the <a href="https://www.cihi.ca/en/infographic-canadas-seniors-population-outlook-uncharted-territory">aging population</a> and an <a href="https://www.chpca.ca/wp-content/uploads/2020/03/CHPCA-FactSheet-D.pdf">increase in chronic illnesses</a> throughout Canada. </p>
<p>In addition to supporting community members, hospice and palliative care should focus efforts on tailoring approaches to provide culturally relevant care, increasing staff education about the lived experiences of older people experiencing homelessness, and creating safe and accessible services in B.C. for marginalized communities. </p>
<p>We must actively dismantle misconceptions about the role of hospice and palliative care through education and awareness to facilitate appropriate service delivery and use for diverse populations.</p><img src="https://counter.theconversation.com/content/204108/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachelle Patille receives funding Canada Mortgage and Housing Corporation (CMHC) and the Social Sciences and Humanities Research Council (SSHRC) in affiliation with the AIRP Project which this piece is linked to.
</span></em></p><p class="fine-print"><em><span>Atiya Mahmood receives funding from Canada Mortgage and Housing Corporation (CMHC) and the Social Sciences and Humanities Research Council (SSHRC) for the AIRP project which this piece is linked to.</span></em></p><p class="fine-print"><em><span>Gracen Bookmyer receives funding Canada Mortgage and Housing Corporation (CMHC) and the Social Sciences and Humanities Research Council (SSHRC) in affiliation with the AIRP Project which this piece is linked to.</span></em></p><p class="fine-print"><em><span>Sarah Canham receives funding from the Canada Mortgage and Housing Corporation (CMHC) and the Social Sciences and Humanities Research Council (SSHRC) in affiliation with the AIRP Project which this piece is linked to.</span></em></p>The challenging realities surrounding end-of-life care are especially difficult for older people experiencing homelessness, who have more barriers to accessing hospice care.Rachelle Patille, Researcher, Aging In the Right Place | M.A. student, Gerontology, Simon Fraser UniversityAtiya Mahmood, Associate professor, Gerontology Department, Simon Fraser UniversityGracen Bookmyer, Research Assistant, Aging In The Right Place | M.A. student, Gerontology, Simon Fraser UniversitySarah Canham, Associate Professor, City & Metropolitan Planning, College Of Social Work, University of UtahLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1990822023-05-02T21:44:36Z2023-05-02T21:44:36ZDoes our gut microbiota really influence our health and life expectancy?<figure><img src="https://images.theconversation.com/files/507937/original/file-20230202-11974-o90i7b.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C991%2C561&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Certain factors can disrupt the gut microbiota. These include our diet, alcohol consumption, antibiotics and inflammatory bowel disease.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The intestinal microbiota is the set of bacteria and viruses that live inside your gut. Microbiota perform a variety of functions, including digesting food and protecting against specific pathogens. </p>
<p>There are several things that can <a href="https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/fecal-transplant">disrupt the gut microbiota</a>, including diet, alcohol consumption, antibiotics and inflammatory bowel disease. These cause imbalances, known as “dysbiosis” which, in turn, are associated with a <a href="https://doi.org/10.1128/mBio.01492-17">wide array of chronic diseases</a>. </p>
<p>In the last decade, the results of hundreds of studies in animal models have suggested that gut dysbiosis may play a role in several metabolic disturbances. Furthermore, in rodents, the implantation of certain bacteria <a href="https://doi.org/10.1038/nm.4236">could influence weight and metabolic profile</a>. What’s more, transferring the gut microbiota from a thin mouse to a heavy mouse allows it to lose weight. Is this too good to be true?</p>
<p>Respectively a student and a full professor in the Department of Medicine at Université Laval, our goal is to identify new therapeutic targets for chronic diseases and healthy life expectancy by using an approach based on genetic epidemiology. This short article aims to summarize and contextualize our recent research work <a href="https://doi.org/10.1186/s12967-022-03799-5">on the gut microbiota</a>.</p>
<h2>The importance of a causal link</h2>
<p>Scientists have suggested that eating certain foods such as dietary fibre, antioxidant-rich fruits and red meat may have an effect <a href="https://doi.org/10.1056/NEJMoa1109400">on the gut microbiota</a>. Some even suggest that microbiota could become a therapeutic target for the prevention or treatment of certain chronic diseases. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="conceptual illustration of the gut microbiome" src="https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507397/original/file-20230131-16-arvjen.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The gut microbiota is the set of bacteria and viruses in our gut. It is involved in various functions, such as the digestion of food and protection against certain pathogens.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>For the microbiota to become a therapeutic target of interest, it is essential to establish a causal link between the characteristics of the gut microbiota and chronic diseases. A causal link suggests that modifying the microbiota <a href="https://doi.org/10.1016/j.cell.2019.12.025">would decrease the risk of developing a disease</a>. However, while several observational (non-experimental) studies in humans have identified statistical associations between <a href="https://doi.org/10.1016/j.febslet.2014.09.039">various markers of gut microbiota and chronic disease</a>, causality has not been clearly established. </p>
<p>For example, it is not known whether gut dysbiosis is the cause or consequence of disease (reverse causation). It is also not known whether both are influenced by other “confounding” factors that are associated with both gut microbiota and chronic disease. One could think, for example, of the quality of <a href="https://doi.org/10.1038/s41586-020-2881-9">our diet, our weight or our alcohol consumption</a>. </p>
<p>So, the aim of our work was to determine whether there is a direct and causal relationship between gut microbiota and metabolic markers such as weight, eight chronic diseases and human longevity using a genetic approach called Mendelian randomization.</p>
<h2>The power of genetic data</h2>
<p>Mendelian randomization attempts to establish causal links from genetic data. To do this, Mendelian randomization uses genetic variants (frequent changes in our genome sequence called nucleotide polymorphisms) that are strongly associated with a risk factor (gut microbiota), to establish a causal link with a dependent variable (health markers and diseases), <a href="https://theconversation.com/voici-comment-les-lois-de-la-genetique-nous-aident-a-prevenir-les-maladies-chroniques-144153">as described in a recent article</a>. Since the variations in our genome are established at the time of embryo formation and remain stable throughout our lives, this natural randomization experiment is not subject to reverse causality bias, since the presence of disease does not influence our genetic code. It is also not subject to the effect of confounding factors, since the genetic variations used are specifically associated with the characteristics of the gut microbiota. </p>
<p>We included genetic data from tens of thousands of individuals from several cohorts. We identified genetic variants associated with 10 fecal and blood metabolites. The metabolites included are small molecules produced by the gut microbiota that have previously been associated with gut dysbiosis and certain diseases. We also identified genetic variants of dozens of microbial taxa (e.g. a species, genus or family of bacteria). We studied nine cardiometabolic traits (weight, blood pressure, blood lipids, insulin, etc.) as well as eight chronic diseases: Alzheimer’s disease, depression, Type 2 diabetes, fatty liver disease, atherosclerotic coronary artery disease, stroke, osteoporosis and renal failure. We also studied the effect of these factors associated with gut microbiota on healthy life expectancy and longevity.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="figure representing several molecules" src="https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=642&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=642&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=642&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=807&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=807&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507393/original/file-20230131-12649-n9up99.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=807&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Small organic molecules called metabolites are produced by gut bacteria. These molecules could reach organs such as the liver and the brain. However, their role in the development of chronic diseases and life expectancy is controversial.</span>
<span class="attribution"><span class="source">(Benoît Arsenault)</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<p>We hypothesised that, in the light of previously published data, a causal link would be revealed between gut dysbiosis and chronic diseases associated with aging.</p>
<p>However, contrary to our hypothesis, this Mendelian randomization analysis did not show significant effects of gut microbiota on metabolic factors and chronic diseases. Seven associations between certain microbial parameters and chronic diseases associated with aging appear to be potentially causal, but their effect is small and we cannot rule out the possibility that these associations happened by chance. Overall, the results offer little support for the hypothesis that the gut microbiota has a significant effect on our weight, metabolism and risk of developing chronic diseases.</p>
<h2>Results that call for caution</h2>
<p>These results suggest that the previously observed associations may not be causal. The associations could be explained by the diseases themselves (reverse causality bias) or by confounding factors (confounding bias) such as diet, medication, smoking, metabolic health, or others. However, these findings are consistent with the results of four recent randomized clinical trials showing that transferring gut microbiota from thin to heavyweight individuals does not lead to <a href="https://doi.org/10.3390/nu11102291">any weight loss or significant improvement in metabolic profile</a>.</p>
<p>Mendelian randomization is a method that has several advantages over observational studies. However, these results need to be contextualized. It is entirely possible that the genetic parameters we used to predict the metabolites and microbial species associated with gut dysbiosis do not fully capture the complexity of the gut microbiota. This would diminish our ability to identify meaningful associations. Therefore, studies with larger sample sizes and better characterization of the gut microbiota and its metabolites will be needed to determine whether certain gut bacteria play a key role in the etiology (the study of causes) of chronic disease and longevity.</p>
<p>Although the impact of gut dysbiosis on chronic disease appears to be limited, gut health is important for other aspects of human health. For example, the microbiota prevents other harmful bacteria from colonizing our gut. In addition, it allows us to digest certain nutrients (e.g. dietary fibre) that would otherwise <a href="https://doi.org/10.1136/bmj.k2179">be rejected by our bodies</a>. </p>
<p>Therapies that modulate the gut microbiota have recently been approved by U.S. health authorities for the prevention of <em>C. difficile</em> infections (a bacterium that causes diarrhea and other serious intestinal diseases). Our results, along with results from clinical studies less prone to reverse causality and confounding bias, do not, however, support a significant effect of gut dysbiosis on chronic disease. </p>
<p>These results support the conclusion that the potential of the microbiota as a therapeutic target for chronic diseases is, at present, low. We urge health professionals and the general public to be cautious about diagnostic tests based on gut microbiota to diagnose health problems that are not validated by the relevant health authorities. </p>
<p>Most importantly, we urge health professionals to avoid recommending specific interventions based on the mere fact that they would influence the parameters of the gut microbiota.</p><img src="https://counter.theconversation.com/content/199082/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Éloi Gagnon has received funding from the Fonds de recherche du Québec - Santé (FRQS).</span></em></p><p class="fine-print"><em><span>Benoit Arsenault has received research funding from the Canadian Institutes of Health Research, the Fonds de recherche du Québec - Santé, the Institut universitaire de cardiologie et de pneumologie de Québec Foundation, Pfizer and Silence Therapeutics.</span></em></p>A new study shows that the gut microbiota has little or no effect on our weight, metabolism and risk of developing chronic diseases.Éloi Gagnon, PhD Candidate, Université LavalBenoit Arsenault, Chercheur au Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec et Professeur titulaire au Département de médecine, Université LavalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1994862023-04-10T12:09:59Z2023-04-10T12:09:59ZHangry bacteria in your gut microbiome are linked to chronic disease – feeding them what they need could lead to happier cells and a healthier body<figure><img src="https://images.theconversation.com/files/519904/original/file-20230406-28-pmixy3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C788%2C443&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The gut microbiome may play a role in regulating the body's appetite, cognition and immune responses. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/gut-bacteria-royalty-free-image/1471910154">nopparit/iStock via Getty Images Plus</a></span></figcaption></figure><p>Diet-related chronic diseases <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/09/27/executive-summary-biden-harris-administration-national-strategy-on-hunger-nutrition-and-health/">have reached</a> a <a href="https://foodperiodictable.org">critical juncture</a> in the U.S. </p>
<p>Nearly half the population has <a href="https://www.cdc.gov/diabetes/data/statistics-report/index.html">prediabetes or diabetes</a>. Over 40% are <a href="https://www.cdc.gov/obesity/data/adult.html">overweight or obese</a>. <a href="https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf">One in nine people over the age of 65</a> has Alzheimer’s disease, the development of which researchers are exploring the <a href="https://doi.org/10.1016/S1474-4422(20)30231-3">potential role of diet</a>. Poor diet is also linked to <a href="https://doi.org/10.1093%2Fnutrit%2Fnuaa025">poor mental health</a>, <a href="https://doi.org/10.1161/CIR.0000000000001031">cardiovascular disease</a> and <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/diet">cancer</a>. It was responsible for <a href="https://www.cspinet.org/eating-healthy/why-good-nutrition-important">nearly 1 in 5 deaths in the U.S.</a> and accounted for <a href="https://doi.org/10.1016/S2468-2667(20)30203-6">over US$140 billion</a> in U.S. health care spending in 2016.</p>
<p>Though American waists are getting bigger, research is showing that the gut microbiome – the bacteria living in our digestive tracts – and the energy-producing compartments of cells, the mitochondria, remain hungry for nutrients missing in the American diet.</p>
<p>I am a <a href="https://gastro.uw.edu/faculty/christopher-j-damman-md-ma">physician scientist and gastroenterologist</a> who has spent over 20 years studying how food can affect the gut microbiome and whole body health. The ultraprocessed food that makes up an <a href="https://doi.org/10.1093/ajcn/nqab305">increasing part the American diet</a> has removed vital nutrients from food. Adding those nutrients back may be important for health in part by feeding the microbiome and mitochondria that turn food into fuel. </p>
<h2>Your health is what you eat</h2>
<p>Research has consistently shown that the <a href="https://doi.org/10.1111/joim.13333">Mediterranean diet</a> and <a href="https://doi.org/10.1016/j.foodres.2022.111501">other whole food diets</a> are associated with better health and longer lives, and <a href="https://theconversation.com/ultraprocessed-foods-like-cookies-chips-frozen-meals-and-fast-food-may-contribute-to-cognitive-decline-196560">ultraprocessed foods and drinks</a> like soda, chips and fast food, among others, are linked with <a href="https://doi.org/10.1080/10408398.2022.2084359">poor health outcomes</a> such as diabetes, cardiovascular disease, cancer and other diseases. </p>
<p>But improving the diet of an individual, let alone a population, is challenging. Whole foods are sometimes <a href="https://www.usda.gov/media/blog/2018/07/24/what-drives-consumers-purchase-convenience-foods">less convenient</a> and <a href="https://doi.org/10.1093/jn/nxab318">less tasty</a> for modern lifestyles and preferences. Furthermore, food processing can be beneficial by <a href="https://www.hsph.harvard.edu/nutritionsource/processed-foods/">preventing spoilage and extending shelf life</a>. <a href="https://doi.org/10.1016/j.gfs.2022.100649">Whole grain processing</a> in particular extends shelf life by removing the germ and bran that otherwise rapidly spoil. Long-term storage of affordable calories has helped address <a href="https://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/food-security-and-nutrition-assistance/">food insecurity</a>, a primary challenge in public health. </p>
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<figcaption><span class="caption">What you eat changes the composition of your gut microbiome.</span></figcaption>
</figure>
<p>Much of the public health conversation around diet has focused on what to avoid: added sugars and refined carbs, some fats, salt and additives. But modern food processing, while increasing the concentration of some nutrients, has removed other key nutrients, producing potential <a href="https://doi.org/10.1038/s43016-019-0013-1">long-term health costs</a>. Equally important is <a href="https://doi.org/10.3390/diseases4010014">what to add back</a> into diets: fibers, <a href="https://theconversation.com/phytonutrients-can-boost-your-health-here-are-4-and-where-to-find-them-including-in-your-next-cup-of-coffee-132100">phytonutrients</a>, micronutrients, missing fats and fermented foods.</p>
<p>Only 5% of the U.S. population gets <a href="https://doi.org/10.1177%2F1559827615588079">sufficient fiber</a>, a prebiotic nutrient linked to metabolic, immune and neurologic health. Americans are likely also deficient in <a href="https://doi.org/10.3390%2Fnu11061355">phytonutrients</a>, <a href="https://doi.org/10.1136/bmj.f1378">potassium</a> and certain <a href="https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/">healthy fats</a> linked to lower rates of cardiovascular disease and cancer. </p>
<p><a href="https://doi.org/10.1038/s41575-020-00390-5">Fermentation</a> is nature’s version of processing, creating foods with natural preservatives, flavors and vitamins. Recent research suggests fermented foods can <a href="https://doi.org/10.1016/j.cell.2021.06.019">improve gut microbiome diversity</a> and dampen systemic inflammation.</p>
<p>Figuring out which bioactive nutrients contribute to disease can help both individuals and institutions develop diets and foods that are personalized to different health conditions, economic constraints and taste preferences. It can also help maximize nutrients in a way that is convenient, affordable and familiar to the modern palate. </p>
<h2>Of microbiomes and mitochondria</h2>
<p>Understanding how nutrients affect the gut microbiome and mitochondria could help determine which ingredients to add to the diet and which to temper.</p>
<p>In your lower gut, bacteria transform undigested bioactive nutrients into <a href="https://doi.org/10.1016/j.tem.2020.12.003">biochemical signals</a> that stimulate gut hormones to slow down digestion. These signals also regulate the immune system, controlling how much of the body’s energy goes toward inflammation and fighting infection, and <a href="https://doi.org/10.3389%2Ffmicb.2022.798917">cognition</a>, influencing appetite and <a href="https://doi.org/10.3390%2Fmicroorganisms9040716">even mood</a>.</p>
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<figcaption><span class="caption">A number of factors are involved in aging.</span></figcaption>
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<p>The microbiome’s biochemical signals also <a href="https://doi.org/10.3389%2Ffmicb.2022.1056499">regulate the growth and function</a> of energy-producing mitochondria across many cell types, including those in fat, muscles, heart and the brain. When these cues are <a href="https://doi.org/10.1038/s43016-019-0013-1">missing in ultraprocessed diets</a>, mitochondria <a href="https://doi.org/10.3390/diseases4010014">function less well</a>, and their dysregulation has been linked to <a href="https://doi.org/10.3389/fendo.2018.00283">obesity</a>, <a href="https://doi.org/10.3389/fphys.2019.00532">diabetes</a>, <a href="https://doi.org/10.1186/s13024-020-00376-6">Alzheimer’s disease</a>, <a href="https://doi.org/10.3389/fpsyt.2021.546801">mood disorders</a> and <a href="https://doi.org/10.1016%2Fj.molcel.2016.02.011">cancer</a>. A better understanding of how diet could improve the function of the <a href="https://doi.org/10.1016/j.advnut.2023.03.016">microbiome-mitochondria axis</a> could help provide a way to reduce the burden of chronic disease.</p>
<p><a href="https://www.britannica.com/biography/Hippocrates">The Greek physician Hippocrates</a>, regarded as the father of medicine, supposedly once said “Let food be thy medicine,” and a <a href="https://doi.org/10.1016/j.advnut.2023.03.016">growing body research</a> suggests that, yes, food can be medicine. I believe that shining a light on the <a href="https://gutbites.org/">connection between diet, health and the microbiome and mitochondria</a> could help societies reach a bright future in which unhealthy aging <a href="https://doi.org/10.1111/obr.13366">isn’t an inevitability</a> of growing older.</p><img src="https://counter.theconversation.com/content/199486/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Damman is medical and science officer at Supergut and on the scientific advisory board at BCD Biosciences.</span></em></p>Research has examined how ultraprocessed foods can contribute to diabetes, cardiovascular disease, cancer and mood disorders. A healthier diet is one way to use food as medicine.Christopher Damman, Associate Professor of Gastroenterology, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2025962023-03-29T19:02:45Z2023-03-29T19:02:45ZLong COVID puts some people at higher risk of heart disease – they need better long-term monitoring<figure><img src="https://images.theconversation.com/files/518051/original/file-20230328-20-25v4zp.jpg?ixlib=rb-1.1.0&rect=0%2C31%2C7118%2C4134&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>Lasting damage to the heart and brain is an aspect of long COVID that should receive much more attention than it has so far. We have sufficient evidence now to call for ongoing monitoring of individuals across the population.</p>
<p>At least one in ten people – and probably more – develop long COVID after the acute infection and many experience persistent debilitating symptoms, including fatigue, a disturbed sense of smell or taste, shortness of breath, brain fog, anxiety and depression. </p>
<p>But a much smaller group of people develops more life-threatening disorders, particularly cardiovascular disease, which includes heart attacks and strokes. The <a href="https://erictopol.substack.com/p/heart-attacks-and-strokes-late-after">scale of this problem</a> is now clearer.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1615083880847114241"}"></div></p>
<p>We know that SARS-CoV-2, the virus that causes COVID, can <a href="https://www.nature.com/articles/s41379-021-00790-1">directly infect heart tissue</a> and cause <a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-021-01359-7">microscopic blood clots</a>, which can sometimes culminate in deep vein thrombosis, pulmonary embolism, myocardial infarction and stroke.</p>
<p>Several studies now show an elevated risk of cardiovascular outcomes following COVID and there may also be hidden pathology that will only emerge as people age. </p>
<p>We need to monitor people with a history of COVID, at least with regular check-ups by family practitioners. Even better, we should establish a registry to facilitate research and healthcare for people at risk.</p>
<h2>Cardiovascular disease after the acute infection has passed</h2>
<p>The first <a href="https://www.nature.com/articles/s41591-022-01689-3">study</a> to present large-scale data on long-term (rather than acute) cardiovascular complications from COVID was based on the national healthcare databases of the US Department of Veterans Affairs. It established a cohort of almost 154,000 individuals with COVID and two comparison groups, each of more that five million. </p>
<p>The research showed that, after 30 days, people with COVID were at increased risk of stroke (1.5-fold higher risk) and transient ischaemic attacks of the brain (1.5-fold), abnormal heart rhythms (1.7-fold), ischaemic heart disease (1.7-fold), pericarditis (inflammation of the outermost layer of the heart; 1.9-fold), myocarditis (inflammation of the heart muscle; 5.4-fold), heart failure (1.7-fold) and clotting disorders (2.4-fold). </p>
<p>These higher risks increased with the intensity of required care during the acute COVID phase but were evident even among those not hospitalised. </p>
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Read more:
<a href="https://theconversation.com/what-the-research-shows-about-risks-of-myocarditis-from-covid-vaccines-versus-risks-of-heart-damage-from-covid-two-pediatric-cardiologists-explain-how-to-parse-the-data-199733">What the research shows about risks of myocarditis from COVID vaccines versus risks of heart damage from COVID – two pediatric cardiologists explain how to parse the data</a>
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<p>Another <a href="https://pubmed.ncbi.nlm.nih.gov/35971425/">study</a> focused on a younger group (mean age of 43 years), using data held by US healthcare organisations, with more than four million individuals who had completed a COVID test. Like the veterans study, follow-up began after 30 days and continued for 12 months. </p>
<p>The researchers compared rates of cardiovascular outcomes for groups with and without COVID infection. Those with COVID had a higher risk of stroke (1.6-fold) and transient ischaemic attacks (1.5-fold), atrial fibrillation (2.4-fold), pericarditis (1.6-fold), myocarditis (4.4-fold), acute coronary artery disease (2.1-fold), heart attack (2-fold), heart failure (2.3-fold) and clotting disorders such as pulmonary embolism (2.6-fold). </p>
<p>The risk of a major adverse cardiovascular event was 1.9-fold higher. Risk for any cardiovascular outcome was about 1.6-fold higher, as was the risk of dying. These higher risks were seen among both men and women. The risk of dying was greater among people aged 65 and older.</p>
<h2>Higher healthcare needs and excess deaths</h2>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/36867420/">most recent study</a> analysed insurance claims from every US state to explore one-year outcomes in a group of more than 13,000 people with long COVID, compared with a matched group of more than 26,000 individuals without a history of COVID. </p>
<p>During follow-up, the long-COVID cohort sought higher healthcare for a wide range of adverse outcomes, including cardiac arrhythmias (2.4-fold higher), pulmonary embolism (3.6-fold), ischaemic stroke (2.2-fold), coronary artery disease (1.8-fold), heart failure (2-fold) as well as emphysema and asthma.</p>
<p>The people with long COVID were more than twice as likely to die than the COVID-free controls.</p>
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Read more:
<a href="https://theconversation.com/supporting-a-child-with-long-covid-tips-from-parents-of-children-living-with-the-condition-195153">Supporting a child with long COVID – tips from parents of children living with the condition</a>
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<p>It is notable these studies produced similar patterns of risk for cardiovascular disease. The risks of both myocarditis and clotting disorders were particularly elevated.</p>
<p>Another study took a different approach, estimating <a href="https://www.nature.com/articles/s44161-023-00220-2">excess deaths</a> due to cardiovascular disease across multiple pandemic waves in the US. From March 2020 to March 2022, there were more than 90,000 excess deaths from cardiovascular disease – 4.9% more than expected. </p>
<h2>What might we be missing?</h2>
<p>These are all observational studies. There is always the concern that some unmeasured variables may explain the findings. However, the close consistency of these studies makes this less likely. The following two reports suggest that, if anything, these studies may be underestimating the size of the problem. </p>
<p>In a community-based <a href="https://pubmed.ncbi.nlm.nih.gov/33785495/">UK prospective study</a> of long COVID among low-risk individuals (low prevalence of comorbidities and only 19% hospitalised with acute COVID), 26% showed mild heart impairment four months after their initial diagnosis. </p>
<p>Cardiovascular MRI scans of 534 individuals with long COVID revealed one in five showed <a href="https://openheart.bmj.com/content/10/1/e002241">some cardiac impairment</a> at six months, which persisted in more than half the group at 12 months. These two studies suggest sub-clinical cardiac disorder may be a much more common manifestation of long COVID than expected.</p>
<h2>Does vaccination help?</h2>
<p>One way to establish whether COVID infection is responsible for the higher rates of cardiovascular disease is to ask whether vaccination reduces risk (as it does with the more common symptoms of long COVID). </p>
<p>Two studies suggest vaccination approximately halves the risk of severe cardiovascular outcomes. A Korean <a href="https://jamanetwork.com/journals/jama/fullarticle/2794753">study</a> shows fully vaccinated people had less than half the risk of both heart attack and stroke compared to an unvaccinated group. </p>
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Read more:
<a href="https://theconversation.com/long-covid-affects-1-in-5-people-following-infection-vaccination-masks-and-better-indoor-air-are-our-best-protections-180668">Long COVID affects 1 in 5 people following infection. Vaccination, masks and better indoor air are our best protections</a>
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<p>A similar <a href="https://pubmed.ncbi.nlm.nih.gov/35925799/">study in the US</a> – with groups categorised as fully vaccinated, partially vaccinated, and unvaccinated – observed most cardiovascular events in the unvaccinated group (12,733 of 14,000). Affected individuals had markedly more co-existing conditions, including previous major cardiovascular events, type 2 diabetes, high blood lipids, ischaemic heart disease, liver disease and obesity. </p>
<p>However, even taking these pre-existing higher risks into account, those who were fully vaccinated had a 41% lower risk. Partial vaccination conferred a 24% lower risk of severe cardiovascular disease. </p>
<p>The need to monitor people with a history of COVID, especially long COVID, is clear.</p><img src="https://counter.theconversation.com/content/202596/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Donne Potter does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many people with long COVID experience persistent debilitating symptoms like fatigue and brain fog. But a few develop more life-threatening and lasting damage to their heart and brain.John Donne Potter, Professor, Research Centre for Hauora and Health, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1988492023-03-15T12:21:15Z2023-03-15T12:21:15ZAre you a rapid ager? Biological age is a better health indicator than the number of years you’ve lived, but it’s tricky to measure<figure><img src="https://images.theconversation.com/files/514749/original/file-20230310-2079-5uhxpf.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2122%2C1410&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Healthspan measures incorporate quality of life in ways that lifespan does not.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-babyboomer-jumping-into-lake-royalty-free-image/92930493">Ira T. Nicolai/The Image Bank via Getty Images</a></span></figcaption></figure><p>Do you ever wake up some days and think, “When I was younger, I could survive on just four hours of sleep, but now it seems like I need 10”? Or have you ever walked out of the gym and “felt” your knees?</p>
<p>Almost everyone experiences these kinds of signs of aging. But there are some people who seem to defy their age. The late U.S. Supreme Court Justice <a href="https://www.cbsnews.com/news/remembering-rbg-justice-ruth-bader-ginsburg-a-woman-who-lived-a-life-defying-expectations/">Ruth Bader Ginsberg</a> stayed on the bench until her death at age 87. The “Great British Bake Off” judge <a href="https://www.bbc.com/news/entertainment-arts-58982697">Mary Berry</a>, now in her 80s, continues to inspire people all over the world to bake and enjoy life. And actor <a href="https://www.washingtonpost.com/arts-entertainment/2021/11/10/paul-rudd-sexiest-man-alive-people/">Paul Rudd</a> was named People magazine’s “Sexiest Man Alive” in 2021 at age 52 while still looking like he’s in his 30s. Is age just a number then? </p>
<p>Researchers have focused a lot of attention on understanding the causes and risk factors of age-related diseases like Alzheimer’s, dementia, osteoporosis and cancer. But many ignore the major risk factor for all of these diseases: aging itself. More than any individual risk factor such as smoking or lack of exercise, the number of years you’ve lived predicts onset of disease. Indeed, aging increases the risk of multiple chronic diseases <a href="https://doi.org/10.1016/j.cub.2012.07.024">by up to a thousandfold</a>. </p>
<p>However, <a href="https://doi.org/10.1038/s41586-018-0457-8">no two people age the same</a>. Although age is the principal risk factor for several chronic diseases, it is an unreliable indicator of how quickly your body will decline or how susceptible you are to age-related disease. This is because there is a difference between your chronological age, or the number of years you’ve been alive, and your biological age – your physical and functional ability.</p>
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<figcaption><span class="caption">As the author notes in her TED Talk, aging is not just a number.</span></figcaption>
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<p>I am a <a href="https://scholar.google.com/citations?user=tqI8C_UAAAAJ&hl=en">scientist interested in redefining “age.”</a> Instead of benchmarking chronological age, my lab is invested in <a href="http://agresearchlab.com">measuring biological age</a>. Biological age is a <a href="https://doi.org/10.1016/j.jacc.2019.11.062">more accurate measure of healthspan</a>, or years lived in good health, than chronological age, and doesn’t directly correlate with wrinkles and gray hairs. Rapid agers experience a faster rate of functional deterioration relative to their chronological age. </p>
<p>My grandmother, who lived to be 83 but was bedridden and could not remember who I was for the last few years of her life, was a rapid ager. My grandfather, on the other hand, also lived until he was 83, but he was active, functional and even did my homework with me until he passed away – he was a healthy ager.</p>
<p>With the unprecedented <a href="https://www.who.int/news-room/fact-sheets/detail/ageing-and-health">growth of the world’s aging population</a>, I believe that figuring out ways to measure biological age and how to maintain or delay its advance is critical not only for individual health, but also for the social, political and economic health of our society. Detecting rapid agers early on presents an opportunity to delay, change or even reverse the trajectory of biological aging. </p>
<h2>Genetics and biological age</h2>
<p>Biological aging is multifaceted. It arises from a complex mix of genetic traits and is <a href="https://doi.org/10.1016/j.jacc.2019.11.062">influenced by factors</a> like microbiome composition, environment, lifestyle, stress, diet and exercise.</p>
<p>Genetics were once thought to have no influence on aging or longevity. However, in the early 1990s, researchers reported the first studies identifying <a href="https://doi.org/10.1098/rstb.2010.0276">genes that were able to extend the lifespan</a> of a small roundworm. Since then, multiple observations support the influence of genetics on aging.</p>
<p>For example, children of long-lived parents and even those with long-lived siblings <a href="https://doi.org/10.1038/ejhg.2011.40">tend to live longer</a>. Researchers have also <a href="https://doi.org/10.1038/s41576-019-0183-6">identified multiple genes</a> that influence longevity and play a role in resilience and protection from stress. These include genes that repair DNA, protect cells from free radicals and regulate fat levels.</p>
<p>However, it is clear from studies in identical twins – who share the same genes but not the same exact lifespans – that genes are not the only factor that influences aging. In fact, genes probably account for only <a href="https://www.scientificamerican.com/article/genetic-factors-associated-with-increased-longevity-identified/">20% to 30% of biological age</a>. This suggests that other parameters can strongly influence biological aging.</p>
<h2>Environmental and lifestyle effects</h2>
<p>Researchers have found that environmental and lifestyle factors heavily influence biological age, including social connectedness, <a href="https://doi.org/10.1001/jamanetworkopen.2021.24387">sleeping habits</a>, <a href="https://www.cnn.com/2023/01/02/health/hydration-disease-aging-death-risk-study-wellness/index.html">water consumption</a>, exercise and diet. </p>
<p><a href="https://doi.org/10.1016/j.alcr.2019.02.002">Social connectedness</a> is essential for well-being throughout life. But social connections can be challenging to maintain over time due to loss of family and friends, depression, chronic illness or other factors. Several studies have reported a <a href="https://doi.org/10.1073/pnas.1219686110">strong link</a> between social isolation and increased stress, morbidity and mortality.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three women dancing together in a park" src="https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514754/original/file-20230310-449-nugrkx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Social connectedness and physical activity are linked to well-being throughout life.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/three-ladies-listening-to-music-and-dancing-royalty-free-image/1152656857">Filippo Bacci/E+ via Getty Images</a></span>
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<p>Similarly, diet and exercise are strong influencers of biological age. <a href="https://doi.org/10.1177/1559827616637066">Blue zones</a>, which are areas around the world where people live long lives, attribute their successful aging to diet, exercise and social connectedness. Mostly plant-based meals and spurts of activity throughout the day are well-known “secrets” of healthspan and longevity. Although newer studies on the effects of diet interventions such as intermittent fasting and time-restricted feeding on longevity have not been rigorously tested, they do show multiple health benefits, including <a href="https://doi.org/10.1007/s00125-022-05752-z">better glucose</a> and <a href="https://doi.org/10.1186/s12986-021-00613-9">insulin regulation</a> </p>
<p>While genetics is difficult to control, diet and exercise can be modified to delay biological aging.</p>
<h2>How to measure biological age</h2>
<p>Currently, there is no effective test to predict an individual’s health trajectory early enough in life in order to intervene and improve quality of life with age. Scientists are interested in identifying a molecule that is sensitive and specific enough to serve as a <a href="https://doi.org/10.1038/s41576-022-00511-7">unique fingerprint for biological age</a>. </p>
<p>Considering the health and resilience of the individual instead of focusing solely on disease state is important in discussions on biological age. Resilience is the state of <a href="https://doi.org/10.1093%2Fgeroni%2Figab046.621">adapting and bouncing back</a> from a health challenge and is often more predictive of functional health. A molecular aging fingerprint may provide a tool to help identify people who are less resilient and require more aggressive monitoring and early intervention to preserve their health and help <a href="https://doi.org/10.1038%2Fs43587-021-00044-4">reduce gender, racial and ethnic health disparities</a>.</p>
<p>There are several promising molecular markers that may serve as biological age fingerprints.</p>
<p>One of these markers are epigenetic clocks. <a href="https://www.cdc.gov/genomics/disease/epigenetics.htm">Epigenetics</a> are chemical modifications of DNA that control gene function. Several scientists have found that DNA can get “marked” by methyl groups in a pattern that changes with age and could potentially act as a <a href="https://theconversation.com/epigenetic-and-social-factors-both-predict-aging-and-health-but-new-research-suggests-one-might-be-stronger-200153">readout for aging</a>.</p>
<p>It is important to note, however, that while epigenetic clocks have been valuable in predicting chronological age, they do not equate to biological age. In addition, it is unclear how these epigenetic marks work or how they contribute to aging.</p>
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<a href="https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older adult holding gold balloons of the number 70 in a backyard" src="https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514752/original/file-20230310-140-5j83gz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Age is so much more than a number.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/happy-man-with-number-70-helium-balloons-in-royalty-free-image/1187298370">Klaus Vedfelt/DigitalVision via Getty Images</a></span>
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<p>Another well-regarded marker of biological age is the build-up of dysfunctional cells called senescent or <a href="https://theconversation.com/cells-become-zombies-when-the-ends-of-their-chromosomes-are-damaged-a-tactic-both-helpful-and-harmful-for-health-186445">zombie cells</a>. Cells become senescent when they experience multiple types of stress and become so damaged that they cannot divide anymore, releasing molecules that cause chronic low-grade inflammation and disease.</p>
<p><a href="https://doi.org/10.1111/acel.12344">Animal studies</a> have shown that getting rid of these cells can improve healthspan. However, what clearly defines senescent cells in humans is still unknown, making them challenging to track as a measure of biological age.</p>
<p>Lastly, the body <a href="https://doi.org/10.1126/sciadv.add6155">releases unique metabolites</a>, or chemical fingerprints, as byproducts of normal metabolism. These metabolites play a dynamic and direct role in physiological regulation and can inform functional health. My lab and others are figuring out the exact makeup of these chemicals in order to figure out which can best measure biological age. A lot of work still remains on not only identifying these metabolites, but also understanding how they affect biological age.</p>
<p>People have long sought a fountain of youth. Whether such an elixir exists is still unknown. <a href="https://doi.org/10.1038/s43587-022-00278-w">But research</a> <a href="https://doi.org/10.1038/ncomms3192">is starting</a> <a href="https://doi.org/10.1073/pnas.2107621118">to show</a> that delaying biological age may be one way to live healthier, fuller lives.</p><img src="https://counter.theconversation.com/content/198849/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aditi Gurkar receives funding from National Institute on Health, Richard King Mellon Foundation, AFAR/Hevolution. </span></em></p>Aging is a major risk factor for many chronic diseases. Figuring out what influences longevity and how to identify rapid agers could lead to healthier and longer lives for more people.Aditi Gurkar, Assistant Professor of Geriatric Medicine, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1996692023-03-03T21:14:58Z2023-03-03T21:14:58ZFamily violence is literally making us sicker – new study finds abuse increases risk of chronic illness<figure><img src="https://images.theconversation.com/files/513038/original/file-20230301-26-19wqam.jpg?ixlib=rb-1.1.0&rect=17%2C107%2C5973%2C3853&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock/Frame Studio</span></span></figcaption></figure><p>More than half (54.7%) of women in New Zealand have experienced violence or abuse by an intimate partner in their lifetime. As we show in our <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.1311?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=030323">new research</a>, this increases their risk of developing a mental health disorder almost three times (2.8 times) and a chronic physical illness almost twice (1.5 times). </p>
<p>More than 1,400 women from a nationally representative sample from the 2019 New Zealand <a href="https://www.tandfonline.com/doi/full/10.1080/1177083X.2020.1862252">family violence study</a> He Koiora Matapopore told us about their experiences of intimate partner violence and their health. We asked them about chronic health problems (heart disease, cancer, stroke, diabetes and asthma) as well as mental health conditions (depression, anxiety or substance abuse). </p>
<p>We also asked women about their lifetime experiences of physical violence, sexual violence, psychological abuse, controlling behaviour and economic abuse by any partner. We used questions from the World Health Organization <a href="https://www.who.int/publications/i/item/924159358X">multi-country study on women’s health and domestic violence against women</a> – the international gold standard for measuring the prevalence of violence against women. </p>
<p>In addition to the physical and mental health problems described above, women who had experienced any of these types of intimate partner violence had increased risk of poor general health (2 times more likely), recent pain or discomfort (1.8 times more likely) and recent healthcare consultations (1.3 times more likely). </p>
<p>Physical and sexual violence hurts people, but it wasn’t just this type of violence that was associated with increased health problems. Women who experienced psychological abuse, controlling behaviours and economic abuse also had greater risk of adverse health outcomes. </p>
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Read more:
<a href="https://theconversation.com/domestic-violence-isnt-about-just-physical-violence-and-state-laws-are-beginning-to-recognize-that-159025">Domestic violence isn't about just physical violence – and state laws are beginning to recognize that</a>
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<h2>Partner violence increases health risks</h2>
<p>It is common for women to experience multiple types of intimate partner violence. One in five women reported experiencing three or more types of partner abuse, and these women had a much higher risk of poor health. </p>
<p>More than one in ten (11%) had experienced four or more types of abuse and these women were over four times more likely to have a mental health condition and double the risk of chronic health problems, compared with women who had not experienced violence by a partner. </p>
<p>Our study reports on lifetime rates of intimate partner violence, but new and recurring violence keeps happening. There were <a href="https://www.police.govt.nz/sites/default/files/publications/annual-report-2021-2022.pdf">175,573 family harm investigations</a> recorded by police in the year to June 2022. People who require police intervention may have even worse health than the women we talked to. </p>
<p>Our findings provide an even stronger rationale for supporting and strengthening strategies to counter the national scourge of intimate partner violence.</p>
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Read more:
<a href="https://theconversation.com/the-covid-19-pandemic-has-made-the-impacts-of-gender-based-violence-worse-193197">The COVID-19 pandemic has made the impacts of gender-based violence worse</a>
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<h2>Our recommendations</h2>
<p>The Manatū Hauora/Ministry of Health’s <a href="https://www.health.govt.nz/our-work/preventative-health-wellness/family-violence-and-sexual-violence">violence intervention programme</a> needs to receive more attention and funding, and Te Whatu Ora/Health New Zealand needs to prioritise implementation. </p>
<p>The programme has developed an infrastructure to provide evidence-based strategies for family violence assessments and intervention. However, it is not well embedded in the health system and needs strong policy, leadership and resourcing to achieve its potential. It also needs to be supported by the health infrastructure to <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2007.01276.x">put it into practice</a>.</p>
<p>Fundamentally, healthcare professionals need to recognise violence experience as a health issue. Effective, regular training about the prevalence and health consequences of intimate partner violence is essential to enable healthcare professionals to help women who have experienced abuse. </p>
<p>This education needs to be embedded in core practitioner training. Universities need to step up to ensure healthcare professionals have the <a href="https://journals.sagepub.com/doi/10.1177/1524838021995951">knowledge and skills</a> they need to address the issue. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-new-national-plan-aims-to-end-violence-against-women-and-children-in-one-generation-can-it-succeed-192497">A new national plan aims to end violence against women and children 'in one generation'. Can it succeed?</a>
</strong>
</em>
</p>
<hr>
<h2>Healing and prevention</h2>
<p>We also need to expand our suite of responses. These must include referral options to help women in times of acute danger and crisis, but also to support long-term recovery and healing from abuse. </p>
<p>Increasing capacity to support healing is one of the key shifts recommended by Te Aorerekura, the <a href="https://tepunaaonui.govt.nz/national-strategy/">national strategy to eliminate family and sexual violence</a>. </p>
<p>We need to invest in evidence-based prevention strategies and ensure they have comprehensive and equitable coverage across the nation. Prevention is one of the recommendations from Te Aorerekura, but the effectiveness of local efforts could get a significant boost if they tapped into <a href="https://ww2preventvawg.org/">international</a> <a href="https://www.whatworks.co.za/">evidence-based prevention strategies</a>. </p>
<figure class="align-center ">
<img alt="This diagram lists strategies to prevent intimate partner violence. The use of this diagram does not imply endorsement by CDC or the US government." src="https://images.theconversation.com/files/513047/original/file-20230301-18-9qomrj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/513047/original/file-20230301-18-9qomrj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=550&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513047/original/file-20230301-18-9qomrj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=550&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513047/original/file-20230301-18-9qomrj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=550&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513047/original/file-20230301-18-9qomrj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=691&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513047/original/file-20230301-18-9qomrj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=691&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513047/original/file-20230301-18-9qomrj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=691&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Strategies to prevent and address the impact of intimate partner violence, developed by the US Centers for Disease Control and Prevention.</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/violenceprevention/pdf/ipv-technicalpackages.pdf">CDC ATSDR</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Prevention initiatives need to be brave enough to address unhealthy forms of masculinity and discrimination against women and girls. Targeting men’s and boys’ understanding of power and control in relationships and engaging them in violence prevention is both <a href="https://link.springer.com/book/10.1057/978-1-137-44208-6">essential and possible</a>. </p>
<p>Developing and sustaining evidence-based prevention and response programmes to address intimate partner violence will require long-term investment and implementation. However, we are already paying for the health and social costs of intimate partner violence. This money could instead be spent fixing it. </p>
<p>Funding work that leads to healthy, respectful relationships could be the “win” we are all looking for. It would yield multiple benefits, including a healthier population, <a href="https://www.aic.gov.au/sites/default/files/2020-05/ti_545_prevent_crime_and_save_money_131218.pdf">fewer incarcerations and criminal justice problems</a>, better educational outcomes and a <a href="https://www.cdc.gov/violenceprevention/pdf/ipv-technicalpackages.pdf">more economically productive society</a>.</p>
<p>Our study also looked at <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800729">men’s experiences of intimate partner violence</a>. It
showed that while the experience can affect men’s health, it did not consistently contribute to men’s poor health at the population level. However, men who experience partner abuse still need care and support options.</p><img src="https://counter.theconversation.com/content/199669/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janet Fanslow has authored the Ministry of Health Family Violence Assessment and Intervention Guideline for Child Abuse and Intimate Partner Violence, and the Ministry of Health Intervention Guideline for Elder Abuse and Neglect.
The research described in this article was funded by the Ministry of Business, Innovation and Employment. </span></em></p>Experience of any form of partner violence increases the risk of developing chronic illnesses. Healthcare professionals need to recognise family abuse as a health issue.Janet Fanslow, Associate Professor in Violence Prevention and Mental Health Promotion, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1999742023-02-21T01:46:35Z2023-02-21T01:46:35ZWe got some key things wrong about long COVID. Here are 5 things we’ve learnt<figure><img src="https://images.theconversation.com/files/511021/original/file-20230220-22-1c304w.jpg?ixlib=rb-1.1.0&rect=80%2C26%2C5910%2C3961&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/worried-young-woman-covering-face-with-hand-6382634/">Pexels/Liza Summer</a></span></figcaption></figure><p>In late 2020 as we hid from COVID behind the moat of “fortress Australia”, we started to hear that in some people, COVID symptoms persisted for months. They were called “long haulers” or had “long COVID”. </p>
<p>Contrary to what we’d expected, it wasn’t just affecting people’s lungs or breathing. Long haulers were experiencing an enormous range of other symptoms: fatigue that was worse after activity, muscle aches and pains, headache, and cognitive dysfunction or brain fog. </p>
<p>A <a href="https://www.aph.gov.au/longandrepeatedcovid">parliamentary inquiry</a> is currently investigating Australia’s response to long COVID – patient experiences, the health system’s response and what the <a href="https://www.nature.com/articles/s41579-022-00846-2">latest research</a> shows. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1626498190735290370"}"></div></p>
<p>It’s now clear we got some key things wrong about long COVID earlier in the pandemic. Three years in, and with an estimated <a href="https://www.nature.com/articles/s41579-022-00846-2">65 million people</a> affected by long COVID, here are five things we now know or suspect about the condition. </p>
<h2>1. It can take months to recover lung function – and some people never do</h2>
<p>We now know full recovery of lung function is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735561/">not guaranteed</a> for people with long COVID: one in five still complain of <a href="https://err.ersjournals.com/content/31/166/220071">severe breathlessness</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9081758/">10%</a> have severe functional impairment. </p>
<p>Among people <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00383-0/fulltext">admitted to hospital</a>, studies report impaired <a href="https://thorax.bmj.com/content/76/4/402">lung function</a>, abnormal chest scans, impaired capacity to exercise and <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00299-6/fulltext">persistent breathlessness</a> months after leaving hospital, especially for those who needed breathing support in ICU.</p>
<p>In those people who where hospitalised with COVID-19 pneumonia and who have persistent breathlessness, pulmonary (lung) rehabilitation improves quality of life and exercise tolerance. While this evidence is not strong, it is consistent, across one <a href="https://pubmed.ncbi.nlm.nih.gov/34312316/">randomised control trial</a> and seven <a href="https://err.ersjournals.com/content/31/166/220071">observational studies</a>.</p>
<figure class="align-center ">
<img alt="Women doing exercise rehab" src="https://images.theconversation.com/files/511037/original/file-20230220-26-mrz4mz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/511037/original/file-20230220-26-mrz4mz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/511037/original/file-20230220-26-mrz4mz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/511037/original/file-20230220-26-mrz4mz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/511037/original/file-20230220-26-mrz4mz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/511037/original/file-20230220-26-mrz4mz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/511037/original/file-20230220-26-mrz4mz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Lung rehabilitation can improve exercise tolerance.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/positive-women-doing-lunges-on-lawn-7266760/">Pexels/Sarah Chai</a></span>
</figcaption>
</figure>
<p>We need a national approach to assess all patients who survive hospitalisation, to determine if they are still breathless and ensuring they have access to pulmonary rehabilitation.</p>
<h2>2. COVID can increase the risk of or worsen chronic diseases</h2>
<p>Early on, we failed to understand COVID would increase the risk and worsen other chronic diseases. </p>
<p>Since then, large population studies have clearly documented people with long COVID are at <a href="https://www.nature.com/articles/s41591-022-01689-3">increased risk</a> of stroke and heart disease and an <a href="https://pubmed.ncbi.nlm.nih.gov/34625431/">increased risk</a> of diabetes. </p>
<p>These problems are <a href="https://www.nature.com/articles/s41579-022-00846-2">more likely</a> in those who are socially disadvantaged, and unable to have sufficient time to recover. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tested-positive-to-covid-go-easy-on-yourself-try-not-to-rush-back-to-work-or-exercise-193712">Tested positive to COVID? Go easy on yourself – try not to rush back to work or exercise</a>
</strong>
</em>
</p>
<hr>
<h2>3. Long COVID isn’t a single disorder</h2>
<p>We initially thought of long COVID as a single disorder. We now know it’s a complex condition, caused by a number of different factors. Emerging evidence suggests this includes: </p>
<ul>
<li><p><a href="https://www.nature.com/articles/s41590-021-01113-x">impaired immunity</a></p></li>
<li><p>the development of <a href="https://pubmed.ncbi.nlm.nih.gov/35216672/">autoantibodies</a> (where the immune system attacks the self)</p></li>
<li><p>the <a href="https://gut.bmj.com/content/71/1/226">persistence</a> of the <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00240-X/fulltext">SARS-CoV-2 virus</a> </p></li>
<li><p><a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01579-5">microclots</a> (small blood clots and/or damage to blood vessels).</p></li>
</ul>
<p>Studies investigating these causes are still small and observational – and these factors are likely overlap and vary among sufferers. The only way to address these issues will be with further research. </p>
<p>A number of treatments are advocated, but they all need to be tested in properly controlled trials, too few of which are in progress. </p>
<figure class="align-center ">
<img alt="Doctor talks to older patient" src="https://images.theconversation.com/files/511038/original/file-20230220-17-p8vr96.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/511038/original/file-20230220-17-p8vr96.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/511038/original/file-20230220-17-p8vr96.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/511038/original/file-20230220-17-p8vr96.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/511038/original/file-20230220-17-p8vr96.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/511038/original/file-20230220-17-p8vr96.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/511038/original/file-20230220-17-p8vr96.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Long COVID is caused by a number of different factors.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-male-patient-consultation-doctor-sitting-1393876184">Shutterstock</a></span>
</figcaption>
</figure>
<h2>4. We need to resource treatment adequately</h2>
<p>In the past we had not devoted sufficient resources to treat post-infectious or immune syndromes such as <a href="https://pubmed.ncbi.nlm.nih.gov/33925784/">myalgic encephalitis</a> or chronic fatigue syndrome (ME/CFS). These syndromes are defined by excessive fatigue, which worsens after exertion, and include cognitive impairment or brain fog. </p>
<p>These symptoms are <a href="https://pubmed.ncbi.nlm.nih.gov/34973396/">responsible</a> for much of the disease and disability associated with <a href="https://pubmed.ncbi.nlm.nih.gov/33925784/">long COVID</a> in <a href="https://pubmed.ncbi.nlm.nih.gov/35079817/">many people</a> and are often more prevalent than respiratory problems. </p>
<p>Severe cases of long COVID, <a href="https://pubmed.ncbi.nlm.nih.gov/20008700/">ME/CFS</a> and other <a href="https://www.nature.com/articles/s41591-022-01810-6">post-infectious syndromes</a> may include a condition known as <a href="https://pubmed.ncbi.nlm.nih.gov/35847821/">POTS</a> (postural orthostatic tachycardia syndrome), where an excessive heart rate results in falls in blood pressure with even mild exertion. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fatigue-after-covid-is-way-more-than-just-feeling-tired-5-tips-on-what-to-do-about-it-179478">Fatigue after COVID is way more than just feeling tired. 5 tips on what to do about it</a>
</strong>
</em>
</p>
<hr>
<p>Unlike survivors of COVID pneumonia, people with POTS are much less likely to benefit from traditional exercise-based rehabilitation programmes. Such programs may even exacerbate their symptoms. </p>
<p>Instead, approaches are proposed that have been previously applied to ME/CFS and POTS are proposed, including exercise pacing, and medication regimes. However, there is a lack of good evidence, and while <a href="https://www.nature.com/articles/s41579-022-00846-2">trials are underway</a>, they are few, especially in Australia.</p>
<h2>5. COVID shouldn’t be dismissed as a psychological problem</h2>
<p>Finally, there has been the problem of attributing long COVID to poor mental health. While worsened mental health <a href="https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health#:%7E:text=Chronic%20illnesses%20such%20as%20cancer,chronic%20condition%20such%20as%20pain.">often accompanies chronic disease</a>, this link for long COVID has been overstated and we are at risk of dismissing the physiological problem. </p>
<p>A <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext">large population study</a> of more than 1.3 million people following COVID demonstrated that while there was an initial increase in anxiety and depression, it was transient, unlike features of long COVID such cognitive dysfunction.</p>
<p>COVID treatment has focused on the acute life-threatening illness and largely ignored the long-term consequences. But long COVID isn’t a problem that will disappear. It requires investigation into the illness it causes, robust clinical trials into treatments and effective models of care. This is not currently happening.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/havent-had-covid-or-a-vaccine-dose-in-the-past-six-months-consider-getting-a-booster-199096">Haven't had COVID or a vaccine dose in the past six months? Consider getting a booster</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/199974/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Wark receives funding from NHMRC Australia, MRFF and NIH.</span></em></p>Three years into the pandemic, it’s now clear we got some things wrong about long COVID early on.Peter Wark, Conjoint Professor, School of Medicine and Public Health, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1993872023-02-12T19:11:26Z2023-02-12T19:11:26ZFair health outcomes start with prevention. The new Centre for Disease Control can make it happen<figure><img src="https://images.theconversation.com/files/509310/original/file-20230209-18-w2n1zt.jpg?ixlib=rb-1.1.0&rect=17%2C8%2C5844%2C3893&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/s/photos/hospital">marcelo leal/unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>For the land of <a href="https://www.jstor.org/stable/20638163">the fair go</a>, Australia has work to do on our health. Although the average Australian’s <a href="https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/life-expectancy">life expectancy</a> is very high, that’s not true for everyone.</p>
<p>Indigenous Australians, and Australians with little formal education, can expect to die about <a href="https://ctgreport.niaa.gov.au/life-expectancy">eight years younger</a> than their fellow citizens. People who live in rural areas will die about <a href="https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health">two to three years earlier</a>, on average, than people who live in cities. </p>
<p>And because chronic diseases create most of these gaps, these disadvantaged people will spend more years living in ill health than other Australians.</p>
<p>These statistics don’t begin to capture the immense suffering behind the numbers, or the deep injustice of gaping health gaps in a wealthy nation like ours. </p>
<p>The government has <a href="https://parlinfo.aph.gov.au/parlInfo/download/media/pressrel/7586055/upload_binary/7586055.pdf;fileType=application%2Fpdf">promised</a> to set up a Centre for Disease Control (CDC), which will tackle both infectious and chronic disease. A new <a href="https://grattan.edu.au/report/acdc-highway-to-health/">Grattan Institute report</a> shows how it can be set up to drive down rates of chronic disease. This will help reduce health disparities, especially if the CDC builds equity into its DNA. </p>
<h2>Chronic disease lies at the heart of health inequities</h2>
<p>Much of the life-expectancy gap between the most and least disadvantaged Australians is explained by skewed rates of chronic disease. </p>
<p>The most disadvantaged fifth of Australians are about 20% more likely to be living with one chronic disease, and about twice as likely to be living with two or more, compared with the most advantaged fifth of Australians. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Rates of chronic disease by disadvantage. Grattan analysis of ABS data (2022).</span></span>
</figcaption>
</figure>
<p>It’s estimated that about <a href="https://www.aihw.gov.au/reports/indigenous-australians/contribution-of-chronic-disease-to-the-gap-in-mort/summary">80% of the gap</a> in life expectancy between Indigenous and non-Indigenous Australians is caused by chronic diseases. </p>
<h2>Gaps in health start before sickness</h2>
<p>Some chronic diseases are difficult to prevent. There is little we can currently do to stop the onset of <a href="https://www.health.gov.au/topics/chronic-conditions/managing-chronic-conditions">type one diabetes or cystic fibrosis</a>, for example. </p>
<p>But other chronic diseases are the result of risk factors such as smoking, alcohol abuse, or being overweight or obese, which we can change. </p>
<p>These so-called modifiable risk factors are the cause of <a href="https://www.aihw.gov.au/news-media/media-releases/2021-1/august/one-third-of-disease-burden-caused-by-modifiable-r">about 40%</a> of the chronic disease burden in Australia. And, like chronic diseases, rates are significantly higher among disadvantaged Australians.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Risk factors for most disadvantaged fifth of the population compared to most advantaged. High alcohol consumption refers to lifetime risk guidelines of no more than two standard drinks per day. Grattan analysis of ABS (2018) and PHIDU (2022).</span>
</figcaption>
</figure>
<p>Compared with the most advantaged fifth of Australians, the most disadvantaged fifth are about 60% more likely to be obese, more than twice as likely to have high psychological distress, almost three times as likely to do no physical activity, and over three times as likely to smoke daily. </p>
<p>This means inequity is already baked in well before people get ill. </p>
<h2>Isn’t being healthy a choice?</h2>
<p>Modifiable risk factors are sometimes branded as “lifestyle choices”. But this glosses over the fact our choices are heavily influenced by environmental and social factors. </p>
<p>For example, more disadvantaged Australians are <a href="https://aifs.gov.au/resources/practice-guides/food-insecurity-australia-what-it-who-experiences-it-and-how-can-child">more likely to</a> find it hard to get or afford sufficient healthy food, which increases the risk of obesity. The increased and often chronic stress that disadvantage brings is associated with <a href="https://www.nature.com/articles/s41598-017-07579-w">smoking more</a>, and may have links with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958156/">obesity</a>. </p>
<p>Disadvantage is also <a href="https://www.vu.edu.au/mitchell-institute/educational-opportunity/socio-economic-disadvantage-educational-opportunity-persistently-linked">intertwined with fewer educational opportunities</a>, and education is <a href="https://www.rand.org/content/dam/rand/pubs/working_papers/WR1000/WR1096/RAND_WR1096.pdf">strongly linked to health</a> because it provides people with better knowledge of health and healthy behaviours. It shapes employment opportunities and can provide a stronger sense of personal control, which helps people make healthier choices. </p>
<p>Many modifiable risk factors may seem like choices, but the causes are often structural. There’s little Australians living in disadvantage can do about these influences, but they all increase the chance of modifiable risk factors, and sickness. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man smoking" src="https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Environmental and social factors heavily influence modifiable risk factors for health, like smoking.</span>
<span class="attribution"><span class="source">reza mehrad/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>A CDC has a chance to reduce health gaps</h2>
<p>The proposed <a href="https://www.health.gov.au/our-work/Australian-CDC">Australian Centre for Disease Control</a>, promised by the Albanese government, is an opportunity to tackle these structural barriers. </p>
<p>The centre has a big job to do. Australia has fallen behind our peers when it comes to prevention. As <a href="https://grattan.edu.au/report/acdc-highway-to-health/">our report</a> shows, <a href="https://stats.oecd.org/">we spend about 2% of the health budget</a> on public health, which is less than one-third of what Canada spends, less than half of what the United Kingdom spends, and far below the OECD average.</p>
<p>While many other countries have introduced <a href="https://www.who.int/news/item/13-12-2022-who-calls-on-countries-to-tax-sugar-sweetened-beverages-to-save-lives">sugar taxes</a> or taken action to reduce people’s intake of <a href="https://academic.oup.com/advances/article/12/5/1768/6159028?login=true">salt</a> and <a href="https://www.who.int/publications/i/item/9789240067233">trans fats</a>, Australia’s prevention progress has largely stalled.</p>
<p><a href="https://grattan.edu.au/report/acdc-highway-to-health/">Our report</a> shows that to have an impact, the CDC must be set up for success, with independence and the right role and resources. And the federal and state governments must make a new funding deal to make the investments the centre recommends.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-should-an-australian-centre-for-disease-control-prepare-us-for-the-next-pandemic-184149">How should an Australian 'centre for disease control' prepare us for the next pandemic?</a>
</strong>
</em>
</p>
<hr>
<h2>A focus on fairness</h2>
<p>Reducing risk factors across the population would have a big impact on health inequity. But to make the biggest gains, the communities at highest risk should be the focus. The CDC should understand who those communities are, and what will work for them.</p>
<p>One of its central roles should be providing technical advice to Australian governments. This advice must take equity into account. </p>
<p>When the centre looks at what works in prevention, it should consider who will benefit. Initiatives that disproportionately benefit disadvantaged groups should be valued more highly. </p>
<p>When the centre advises government on progress and targets, it should reflect not just how the average Australian is going, but also the status of groups that have traditionally been left behind. </p>
<p>To help the centre understand health disparities and the perspectives of people who experience them, the staff, leadership and culture of the centre should be diverse and inclusive, representing the broader community. And the centre should also listen to different groups that face the biggest barriers to good health, using a range of consultation and engagement methods. </p>
<p>Narrowing the health gap that divides Australians won’t happen overnight. And not all the structural barriers that create health inequalities can be solved by another government agency. </p>
<p>But for too long, these gaps have received too little attention. A strong, equity-focused CDC can help ensure that, when it comes to their health, all Australians get a fair go.</p><img src="https://counter.theconversation.com/content/199387/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Albanese government has promised a centre for disease control. Its main focus has to be health equity for disadvantaged groups.Peter Breadon, Program Director, Health and Aged Care, Grattan InstituteLachlan Fox, Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1957112023-01-03T13:31:48Z2023-01-03T13:31:48ZWhy you should give the gift of mindfulness this New Year<figure><img src="https://images.theconversation.com/files/501568/original/file-20221216-13-lva9n.jpg?ixlib=rb-1.1.0&rect=44%2C32%2C4236%2C2811&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The late Zen master Thich Nhat Hanh leading a meditation walk.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/pupil-cheng-ka-ki-looks-surprised-as-zen-master-thich-nhat-news-photo/1125039441?phrase=walking%20mindfulness&adppopup=true">Steve Cray/South China Morning Post via Getty Images</a></span></figcaption></figure><p>The start of another year can feel <a href="https://theconversation.com/symbolic-gestures-magical-thinking-new-years-resolutions-34243">magical</a> to many of us. Even though the days remain short and dark, the flip of the calendar can make it seem new beginnings with new resolutions are possible. </p>
<p>Mindfulness scholars and teachers <a href="https://jeremydavidengels.com">like me</a> call resolutions “<a href="https://books.google.com/books/about/Mindfulness.html?id=BV_YAAAAQBAJ">habit breakers</a>,” as they can overcome patterns that no longer serve individuals. However, research <a href="https://theconversation.com/9-tips-to-give-yourself-the-best-shot-at-sticking-to-new-years-resolutions-151372">suggests</a> that many resolutions fail by the end of January. </p>
<p>But a <a href="https://www.health.harvard.edu/staying-healthy/seven-steps-for-making-your-new-years-resolutions-stick">key to ensuring that resolutions stick</a> is to choose one that will make a meaningful difference in your life. Seeing a real, tangible benefit can provide inspiration to keep going when all of life is telling us to let things go back to how they were before. </p>
<p><a href="https://www.forbes.com/sites/joyceearussell/2021/12/27/new-years-resolutions-again-set-yourself-up-for-success-this-time/?sh=4c281563795a">Living more mindfully</a> is a common New Year’s resolution. This year, try gifting it to others.</p>
<h2>The meaning of mindfulness</h2>
<p>Mindfulness has been shown to have <a href="https://theconversation.com/how-effective-is-mindfulness-for-treating-mental-ill-health-and-what-about-the-apps-182436">a number of meaningful health benefits</a> – it can help reduce anxiety and promote healing in those <a href="https://www.penguinrandomhouse.com/books/89149/full-catastrophe-living-revised-edition-by-jon-kabat-zinn-preface-by-thich-nhat-hanh-foreword-by-joan-borysenko/">suffering</a> from long-term chronic illness. </p>
<p>The practice is based on an insight <a href="https://theconversation.com/has-the-modern-world-discovered-the-ancient-truths-of-buddhism-or-simply-invented-a-new-version-191132">first described by ancient Buddhist texts</a> that human beings have the capacity to observe experience <a href="https://tricycle.org/article/satipatthana-sutta-mindfulness/">without being caught up in it</a>. This means, simply and wonderfully, that it is possible to observe ourselves having a craving, or a happy thought, or even a scary emotion, without reacting in the moment in a way that amplifies the feeling or sends the mind spiraling off into thinking about old memories or anticipating events.</p>
<p>This practice can help <a href="https://www.penguinrandomhouse.com/books/204352/the-miracle-of-mindfulness-by-thich-nhat-hanh/">calm the mind and the body</a> as we learn not to react to experience with likes and dislikes or judgments of good and bad. It does not make us cold or apathetic but <a href="https://www.penguinrandomhouse.com/books/565790/the-inner-work-of-racial-justice-by-rhonda-v-magee-foreword-by-jon-kabat-zinn/">more fully present</a>. </p>
<h2>Mindfulness in a distracted world</h2>
<p>One of the challenges of practicing mindfulness in our contemporary world is that there has been a profound transformation in human attention. The artist Jenny Odell <a href="https://www.penguinrandomhouse.com/books/600671/how-to-do-nothing-by-jenny-odell/">argues</a> that in our “attention economy” human attention has been transformed into a commodity that big corporations buy and sell. This economy rests on a technological revolution of mobile phones and social media that makes it possible for corporations to reach us with content that can capture and monetize our focus, at every moment, every day, and no matter where we may be. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/501572/original/file-20221216-11243-atvlov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three men wearing suits looking at their phones." src="https://images.theconversation.com/files/501572/original/file-20221216-11243-atvlov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501572/original/file-20221216-11243-atvlov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=485&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501572/original/file-20221216-11243-atvlov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=485&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501572/original/file-20221216-11243-atvlov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=485&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501572/original/file-20221216-11243-atvlov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=610&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501572/original/file-20221216-11243-atvlov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=610&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501572/original/file-20221216-11243-atvlov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=610&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The constant need to be checking our phones keeps us from being fully present.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-check-their-phones-during-the-test-of-nationwide-news-photo/1245456555?phrase=people%20on%20phones&adppopup=true">Abdulhamid Hosbas/Anadolu Agency via Getty Images</a></span>
</figcaption>
</figure>
<p>The needy little devices most people carry in their pockets and wear on their wrists, incessantly beeping and buzzing and chirping, are a perpetual diversion from the present moment. The result is that it can feel as though our ability to focus, and be fully present, <a href="https://stolenfocusbook.com">has been stolen</a>. </p>
<p>But mindfulness can help us resist the attention economy and savor the things that make life special, like being together with those we love. </p>
<h2>The gift of mindfulness</h2>
<p>While most mindfulness research focuses on the individual benefits of the practice, <a href="https://press.uchicago.edu/ucp/books/book/chicago/E/bo68657749.html">scholars like me argue</a> that we not only practice mindfulness for ourselves but that we can also practice it for others. It can help us build stronger, healthier relationships. </p>
<p>The sad truth is that living in the attention economy, most of us have become <a href="https://www.psychologytoday.com/us/blog/play-your-way-sane/202108/were-worse-listening-we-realize">bad listeners</a>. However, just as it is possible to watch ourselves having an experience without reacting, it’s possible to watch another person have an experience without getting tied up in reactivity and judgment. It’s possible simply to be present. </p>
<p>The gift of mindfulness is a practice of listening with <a href="https://doi.org/10.1080/15427609.2018.1495002">compassion</a> to another person describe their experiences. To give this gift means putting away your phone, turning off social media, and setting aside other common distractions. It means practicing being fully present in another person’s presence and <a href="https://www.parallax.org/product/the-art-of-communicating/">listening</a> to them with complete attention, without reacting with judgment, while resisting the urge to make the interaction about you. </p>
<p>If we judge the value of gifts <a href="https://books.google.com/books?id=2OyzetozsTsC&q=cost#v=snippet&q=cost&f=false">based on how much they cost</a>, this gift may seem worthless. But in a distracted world, I argue, it is a <a href="https://books.google.com/books/about/The_Art_of_Gratitude.html?id=Glp5swEACAAJ">precious one</a>. </p>
<p>It is not a gift that you will wrap, or put inside a card; it’s not one you will have to name as a gift or draw attention to. It’s something you can do right now.</p><img src="https://counter.theconversation.com/content/195711/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeremy David Engels does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Mindfulness can teach us to be more present – not just for ourselves, but also for our colleagues, friends and loved ones.Jeremy David Engels, Professor of Communication Arts and Sciences, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1906662022-12-12T23:35:11Z2022-12-12T23:35:11ZWith so many GPs leaving the profession, how can I find a new one?<figure><img src="https://images.theconversation.com/files/499451/original/file-20221207-24-bxleyf.jpg?ixlib=rb-1.1.0&rect=46%2C18%2C6155%2C3484&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-male-pediatrician-hold-stethoscope-600w-1463202677.jpg">Shutterstock</a></span></figcaption></figure><p>Perhaps you have been happily attending the same GP for many years. They know your medical history better than anyone. Then all of a sudden they retire, or the practice closes, or it gets taken over by a bigger company and everything at the practice changes. Or maybe you’ve just had an unexpected visit to hospital and they ask who your GP is on discharge, then you realise you’re in need of one. </p>
<p>More than 80% of Australians <a href="https://pubmed.ncbi.nlm.nih.gov/29779298/">visit a GP</a> each year and those with chronic medical conditions will attend multiple times within the same period. It’s important to have a good GP who can coordinate your care. So how do you find a new one to develop a trusted relationship with? </p>
<p>As practising GPs ourselves, we are often asked: “Do you know a good GP?” This can be a somewhat difficult question to answer, as each person’s perception of “good” is highly subjective, dependent on many factors.</p>
<p>Studies of peoples’ preferences have varied results. One study found the <a href="https://pubmed.ncbi.nlm.nih.gov/21334160/">listening ability</a> of the GP to be important. Other studies found patients put more value in <a href="https://pubmed.ncbi.nlm.nih.gov/18332402/">clinical competency</a>, a <a href="https://bjgp.org/content/70/698/e676">trusting relationship or continuity of care</a>. </p>
<p>So a better question is: what GP will be a good fit for me?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gps-are-abandoning-bulk-billing-what-does-this-mean-for-affordable-family-medical-care-182666">GPs are abandoning bulk billing. What does this mean for affordable family medical care?</a>
</strong>
</em>
</p>
<hr>
<h2>What factors are important to you? 6 aspects to consider</h2>
<p>Here are some tips to help speed up your search for your new GP. Remember though, it may take a few visits to develop a trusting relationship and know if the fit is right for you. </p>
<h2>1. Your health needs</h2>
<p>If you are young and healthy, a GP offering a convenient service and who is easy to book in quickly with may suffice. For those living with chronic complex conditions or disabilities who need to visit often, a consistent and thorough doctor is recommended. </p>
<h2>2. Cost</h2>
<p>Bulk-billing doctors are becoming rarer given the rising cost of services, salaries, equipment and utilities. To stay afloat, these doctors are having to see more patients in less time. </p>
<p>This could result in a poorer understanding of you as an individual and your health values and goals. Again, this might not be a problem for simple consults. But if you get a serious disease down the track, you might wish you’d had a regular GP all along, because they would know you and your history. </p>
<p>If you’re able to wear some extra cost but wondering how much to pay, consider the Australian Medical Association recommendation as your guide – a standard 15-minute <a href="https://www.ausdoc.com.au/news/rebate-gap-blows-out-47-standard-gp-consult/#:%7E:text=In%20its%20latest%20list%20of,currently%20sits%20at%20just%20%2439.10.">consult cost</a> is $86 with a $39 rebate from Medicare. </p>
<h2>3. Accessibility and practice size</h2>
<p>Consider the distance you need to travel and the opening hours you may need, including weekend availability. </p>
<p>Bigger practices are more likely to be able to get you in to see a doctor, if not your doctor, and often have longer opening hours. Having more than one preferred GP within the same practice can provide more flexibility and they will each be able to access your medical records and results. You may want to enquire also about disability access and telehealth options.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-businesses-are-offering-online-medical-certificates-and-telehealth-prescriptions-what-are-the-pros-and-cons-194154">More businesses are offering online medical certificates and telehealth prescriptions. What are the pros and cons?</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="doctor's waiting room" src="https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You may be able to see a doctor more quickly at a larger practice.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-couple-face-masks-sitting-600w-1828070570.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<h2>4. Reviews</h2>
<p>Online recommendations can be tricky to interpret. Only <a href="https://www.center4research.org/believe-online-reviews-doctors/">6–8% of people</a> post online reviews for doctors. And there are plenty of people out there who have inappropriate requests or expectations of GPs, which may be their basis for a negative review. Also, someone who has been happily seeing their GP for decades is less likely to post a rating than a one-off visitor. </p>
<p>Be sure to consider what reasons were given for a negative review – was it because of actions taken, an attitude, or a personality clash? – and how those reasons align with your preferences. In saying that, community Facebook groups are often a hotspot for discussions about local GPs and recurrent positive recommendations can and should be held in higher regard. </p>
<h2>5. New doctors</h2>
<p>There are many young GPs starting off in the profession or new to the area. Many will be fantastically caring and competent. But these doctors are not going to come with recommendations yet. </p>
<p>These GPs often have plenty of appointment slots, and the most recent up-to-date training. Being an early adopter of their services could be to your benefit. </p>
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Read more:
<a href="https://theconversation.com/how-do-you-fix-general-practice-more-gps-wont-be-enough-heres-what-to-do-195447">How do you fix general practice? More GPs won't be enough. Here's what to do</a>
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<h2>6. Sub-specialists</h2>
<p>Many GPs have special interests and advanced skills, such as skin cancer care, musculoskeletal medicine, women’s health or mental health. </p>
<p>They may have done postgraduate training, usually listed on the practice website along with their special interests. They are likely to have a shorter waiting time and lower costs than specialists – so consider these doctors if your needs match their expertise. </p>
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<h2>Other things to check</h2>
<p>About 80% of practices go through a <a href="https://www.semphn.org.au/general-practice-accreditation">practice accreditation process</a>, which proves attainment of standards set by the Royal Australian College of General Practitioners. Such practices will advertise this status on their website and at the entrance to the clinic.</p>
<p>You can also ask about a doctor’s qualifications and about the standard consultation length. This may range from 10 to 20 minutes. Don’t be afraid to ask these questions when calling a practice about your first visit.</p>
<p>The final and arguably most important test is how you connect when you meet them in person. Finding a GP can be like finding your favourite cardigan. You don’t know it’s your favourite until it has been worn in. </p>
<p>Similarly you don’t know that your GP is great until you’ve journeyed with them through some potentially challenging times of your life. We encourage you to use the above tips to find a suitable GP, then give them some time to get to know you and grow a therapeutic relationship. </p>
<p>With continuity of care, trust will grow, as will knowledge about you and your values. This will ultimately improve your overall health care experience. </p>
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<strong>
Read more:
<a href="https://theconversation.com/general-practices-are-struggling-here-are-5-lessons-from-overseas-to-reform-the-funding-system-188902">General practices are struggling. Here are 5 lessons from overseas to reform the funding system</a>
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<img src="https://counter.theconversation.com/content/190666/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>‘See your GP’ is standard advice. But what if you don’t have one? Or yours is shutting up shop? Here’s how to find a new GP who suits you.David King, Senior Lecturer in General Practice, The University of QueenslandRhys Cameron, Senior lecturer, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1938352022-11-17T21:50:17Z2022-11-17T21:50:17ZHealthcare for New Zealanders with multiple chronic conditions needs ‘radical rethinking’ – here’s what should happen<figure><img src="https://images.theconversation.com/files/495779/original/file-20221117-27-ga6i04.jpg?ixlib=rb-1.1.0&rect=46%2C303%2C7734%2C4759&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>One in four New Zealanders have more than two chronic conditions, including both <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/long-term-conditions/management-multimorbidity">physical and mental health issues</a>.</p>
<p>The COVID pandemic has highlighted how difficult it can be for people with multiple pre-existing conditions to access health services and <a href="https://journals.sagepub.com/doi/full/10.1177/2235042X20971168">receive the most suitable care</a>. For those living in poverty or challenging family and social circumstances, it can be even harder. </p>
<p>We have evaluated a new model designed to provide care for people with multiple chronic health and social needs. </p>
<p>Our findings show it was less effective than anticipated in reducing health inequities. But it nevertheless delivered useful lessons to incorporate into New Zealand’s <a href="https://www.healthnavigator.org.nz/healthcare-in-nz/health-system-reform/">current health reform process</a>.</p>
<p>Primary care has been endorsed as the best place to support people with chronic conditions, many of whom are <a href="https://ojs.victoria.ac.nz/pq/article/view/5299">older</a>. It focuses on patient-centred care to avoid hospitalisations and provides regular disease screening.</p>
<p>But since the pandemic, staffing issues have limited access to face-to-face primary care services and increased demand on emergency departments, which are not structured to provide care for those with complex health and social needs.</p>
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<p>Client Led Integrated Care (<a href="https://wellsouth.nz/community/clinical-service/client-led-integrated-care-clic/">CLIC</a>) is a model of care specifically for people with multiple chronic conditions. It is based on the principles of the global <a href="https://access.portico.org/Portico/auView?auId=ark%253A%252F27927%252Fphwwtrq3nv&auViewType1=PDF">chronic care model</a> and was envisaged as a proactive programme based on best-practice guidelines. </p>
<p>One of its goals was to reduce health inequities, particularly for Māori, Pacific people, vulnerable older adults and those living in poverty. Another significant aim was to provide appropriate levels of care to reduce demand on hospitals. </p>
<p>Our assessment during the four years since the programme was implemented in general practices in the southern district of Aotearoa, from 2018 to 2022, shows it has not been effective in reducing health inequities.</p>
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<strong>
Read more:
<a href="https://theconversation.com/living-with-complex-illness-and-surviving-to-tell-about-it-anna-spargo-ryans-chronic-optimism-189135">Living with complex illness and surviving to tell about it: Anna Spargo-Ryan's chronic optimism</a>
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<h2>What’s wrong with current care for chronic conditions?</h2>
<p>CLIC and similar chronic conditions programmes developed over the past 20 years focus on trying to teach people how to change lifestyle factors which <a href="https://www.sciencedirect.com/science/article/abs/pii/S0140673604172772">may have contributed to their illness</a>. </p>
<p>CLIC is based on an annual one-on-one holistic assessment. Patients are prioritised depending on their likelihood of requiring hospitalisation. Support focuses on changing negative lifestyles and managing medications. The programme also aims to encourage regular engagement with health professionals to meet goals from mutually developed care plans. </p>
<p>Although this sounds good, the prioritisation process does not identify those with the greatest ability to benefit from change. Neither does it address the needs which may matter the most, such as not having enough money for healthy food or to regularly attend a general practice.</p>
<p>There is little or no consideration of the personal resources required for people to achieve their health goals and minimal understanding of the lack of funding in primary care to address poverty and associated issues. </p>
<figure class="align-center ">
<img alt="A man having his blood sugar measured by a doctor or nurse" src="https://images.theconversation.com/files/495801/original/file-20221117-15-kfb3w9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495801/original/file-20221117-15-kfb3w9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495801/original/file-20221117-15-kfb3w9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495801/original/file-20221117-15-kfb3w9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495801/original/file-20221117-15-kfb3w9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495801/original/file-20221117-15-kfb3w9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495801/original/file-20221117-15-kfb3w9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Healthcare for people with chronic conditions often fails to address the most pressing needs, such as having enough money to buy healthier food.</span>
<span class="attribution"><span class="source">Getty Images</span></span>
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<h2>Better outcomes for people with complex needs</h2>
<p>The reason CLIC has not worked uniformly is because people’s ability to manage their health is complex. Social determinants of health – including income and job security, education, housing and food insecurity, social inclusion and non-discrimination – influence outcomes.</p>
<p>These determinants can either be protective or confer risk. Social factors that put people at higher risk are complex and involve power dynamics, such as the long-term impacts of colonisation and the influence of government policies that don’t consider social determinants.</p>
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Read more:
<a href="https://theconversation.com/disempowered-shut-off-and-less-able-to-afford-healthy-choices-how-financial-hardship-is-bad-for-our-health-192241">Disempowered, shut off and less able to afford healthy choices – how financial hardship is bad for our health</a>
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<p>The ongoing health reforms must recognise the challenges of living with clinical complexity while also being negatively affected by these determinants. We need radical rethinking to provide more than standard models of care if Aotearoa is to improve health outcomes for a growing number of people. </p>
<p>Key changes include the removal of barriers such as patient fees for primary care services and providing alternatives to nine-to-five clinic consultations. Incorporating family, social and community connections to support people to improve their health and their social circumstances is also a valuable strategy.</p>
<p>New models of care for those with chronic conditions must consider social determinants and ensure health programmes work for both the people receiving them and those delivering them. Care must be provided across both primary and hospital facilities and be integrated with social services. </p>
<p>Most importantly, when developing (and appropriately funding) new models of care, it is vital to acknowledge people’s expertise in prioritising their own health. It is crucial such programmes consider individual life circumstances and people’s capability and access to resources (or the lack thereof) to manage their health.</p>
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<p><em>The author would like to acknowledge the support of Fiona Doolan-Noble, Eileen McKinlay and Chrystal Jaye in writing this article.</em></p><img src="https://counter.theconversation.com/content/193835/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Askerud received PhD funding from WellSouth Primary Health Network, Southlink Education Trust and the HOPE Foundation through the University of Otago. She currently works as a senior lecturer at Otago Polytechnic Te Pūkenga School of Nursing.</span></em></p>If we want people with complex care needs to prioritise their health, cutting patient fees, providing flexible hours and paying attention to their social circumstances would be a good start.Anna Askerud, PhD candidate, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1933612022-10-28T15:19:02Z2022-10-28T15:19:02ZThree reasons to eat pumpkins instead of carving them this Halloween<figure><img src="https://images.theconversation.com/files/492301/original/file-20221028-44561-qd6t0h.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5607%2C3732&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pumpkins are regularly consumed as part of many diets around the world. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fresh-cooked-pumpkin-soup-served-stuffed-2038223663">Zulfiska/ Shutterstock</a></span></figcaption></figure><p>Pumpkins are synonymous with autumn. But while most of us associate them with Halloween, pie and pumpkin spice lattes, these fruits are in fact extremely versatile. And depending on how they’re prepared, they can be good for your health. </p>
<p>Though pumpkins are grown all year round, most of us only buy them in October for carving into jack-o’-lantern. This means many are missing out on a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9182978/">surprisingly nutritious food</a> from their diet. Pumpkins are nutrient-dense while being low in calories. They contain a variety of vitamins, minerals and antioxidants that each have <a href="https://www.sciencedirect.com/science/article/pii/S2468227620303136">different benefits for our health</a>. </p>
<p>Here are just a few of the reasons you should consider including pumpkins in your diet. </p>
<h2>1. They’re a source of antioxidants</h2>
<p>Pumpkins contain high levels of antioxidants. These are molecules that fight harmful free radicals (a type of unstable molecule that can sometimes cause <a href="https://www.frontiersin.org/articles/10.3389/fphys.2020.00694/full">damage to our cells</a>, which may cause ageing and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5927356/">contribute to various diseases</a> over time). While some antioxidants <a href="https://www.mdpi.com/journal/antioxidants">occur naturally in our bodies</a>, others we get from fruits and vegetables. </p>
<p>The high antioxidant content in pumpkins could therefore be associated with a lower risk of developing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249911/#:%7E:text=A%2520free%2520radical%2520can%2520be,are%2520unstable%2520and%2520highly%2520reactive">certain diseases</a>, such as heart disease and cancer. </p>
<p>Pumpkins are also one of the best sources of the antioxidant beta-carotene. Not only does this give pumpkins their vivid orange colour, but it’s also converted into <a href="https://ods.od.nih.gov/factsheets/VitaminA-Consumer/">vitamin A</a> which is essential for good vision, our immune system and even heart and lung function. </p>
<p>Pumpkins also contain vitamins C and E, antioxidants that are known to <a href="https://www.mdpi.com/2072-6643/12/6/1562/htm">strengthen our immune systems</a>. In addition, <a href="https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/">vitamin C</a> is important for wound healing and helping the body build collagen – a fibrous protein used in our connective tissues – including our bones, muscles and even blood. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997530/">Vitamin E</a> on the other hand is good for preventing clots from forming and may also be good for our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976416/">skin, hair and nails</a>. </p>
<h2>2. They’re full of important minerals</h2>
<p>Pumpkins contain both iron and folate. </p>
<p><a href="https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/">Iron</a> of course is important in helping our red blood cells carry oxygen from the lungs to tissues around the body. It also helps to keep our muscles and connective tissues healthy. Iron helps to preserve many vital functions in the body including energy and focus, gastrointestinal processes, the immune system, regulation of temperature and growth and neurological development. </p>
<p>Folate, also known as <a href="https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/">vitamin B9</a>, is an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363433/">essential nutrient</a> that supports the formation of DNA and RNA. This is why it’s particularly important during pregnancy, infancy and adolescence. Low levels of folate are associated with an increased risk of several health conditions, including <a href="https://www.sciencedirect.com/science/article/pii/S2211335521003089?via%3Dihub">birth defects</a> and <a href="https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-14-6">cardiovascular disease</a>. Research also shows that folate is linked to a reduce risk of <a href="https://www.oncologynutrition.org/erfc/healthy-nutrition-now/folate-and-cancer#:%7E:text=In%20fact%2C%20laboratory%20studies%20have,pancreatic%2C%20esophageal%20and%20colorectal%20cancer">pancreatic, oesophagal and colorectal cancer</a>. </p>
<p>It should be noted that pumpkins are high in potassium, too, so patients on dialysis will need to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224083/">limit their intake</a>.</p>
<h2>3. Even pumpkin seeds pack a punch</h2>
<p>Although they’re small, pumpkin seeds are also <a href="https://www.sciencedirect.com/science/article/pii/S2468227620303136">packed full of valuable nutrients</a>.</p>
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<img alt="A person holds a carved Halloween pumpkin in their hands." src="https://images.theconversation.com/files/492302/original/file-20221028-41756-9r59pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492302/original/file-20221028-41756-9r59pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492302/original/file-20221028-41756-9r59pd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492302/original/file-20221028-41756-9r59pd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492302/original/file-20221028-41756-9r59pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492302/original/file-20221028-41756-9r59pd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492302/original/file-20221028-41756-9r59pd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Save your seeds after pumpkin carving instead of throwing them away.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/making-scary-pumpkin-jack-halloween-holiday-1823667131">kobeza/ Shutterstock</a></span>
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<p>For example, pumpkin seeds contain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5926493/">magnesium</a>, a mineral that supports muscle and nerve function, regulates blood pressure and supports the immune system. They also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724376/">contain zinc</a>, which alongside supporting our immune system also plays an important role in cell growth, building DNA and protein and healing damaged tissue. </p>
<p>Another perk of pumpkin seeds is that they contain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071289/">unsaturated fatty acids</a>, which help lower levels of <a href="https://www.ncbi.nlm.nih.gov/books/NBK519561/">LDL cholesterol</a> (often known as “bad” cholesterol as it contributes to fatty build-up in arteries and can raise the risk of heart attacks or stroke, reduce inflammation and strengthen our cells). </p>
<p>They also contain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075620/">many of the same antioxidants</a> pumpkins do.</p>
<h2>How to prepare your pumpkin</h2>
<p>Pumpkins are a versatile fruit that is <a href="https://doi.org/10.1016%2Fj.heliyon.2019.e02462">regularly consumed</a> in many different parts of the world. It can be prepared in a variety of different ways. </p>
<p>For example, when carving a jack-o’-lantern this year, instead of throwing your seeds away, separate them from the flesh, rinse them off, and set them to the side. Once they’re dry, roast them – either plain or perhaps consider topping them with honey. This is a popular dessert in Mexico known as <em>palanquetas</em>. You can also use the flesh (or pulp) in several dishes, including in <a href="https://www.goodto.com/food/how-to-use-up-leftover-pumpkin-113390">soup or a puree</a>, or even in desserts, such as muffins, pudding or flan. </p>
<p>The fruit itself can be peeled and prepared or eaten as you would any other vegetable. As with other winter vegetables – such as squash – it goes particularly well with chilli, nutmeg and sage. Or perhaps you’d like to try preparing your pumpkin as they do in other parts of the world. In Armenia, pumpkin is used in the dish <em>ghampama</em>, in which the inside of a pumpkin is stuffed with boiled rice, dried fruits, nuts and honey before it’s cooked. Or maybe you’d prefer to try South African <em>pampoenkoekies</em>, which are tiny pumpkin fritters made with cinnamon and nutmeg.</p>
<p>Each year thousands of acres of farmland are used to grow pumpkins which are merely carved and then thrown away. This could be considered a waste of valuable, nutritious and delicious food. So this year, you might want to consider turning your jack-o’-lantern into a delicious, homemade meal instead.</p><img src="https://counter.theconversation.com/content/193361/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hazel Flight does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Pumpkins are a versatile fruit that can be prepared in many different ways.Hazel Flight, Programme Lead Nutrition and Health, Edge Hill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1908242022-10-25T09:06:46Z2022-10-25T09:06:46ZFour ways to support a friend or loved one with long COVID<figure><img src="https://images.theconversation.com/files/488766/original/file-20221007-16-t56ggp.jpg?ixlib=rb-1.1.0&rect=0%2C6%2C4211%2C2798&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/view-behind-two-girlfriends-lesbian-couple-336786272">Gajus/Shutterstock</a></span></figcaption></figure><p>An estimated <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/6october2022">2.3 million people</a> in the UK are currently living with long COVID. The condition is most commonly reported by people aged 35-69, but it can affect people of any age. And many young people will also face the need to support friends or relatives.</p>
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<iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/four-ways-to-support-a-friend-or-loved-one-with-long-covid-190824" &bgcolor="F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p><em>You can listen to more articles from The Conversation, narrated by Noa, <a href="https://theconversation.com/us/topics/audio-narrated-99682">here</a>.</em></p>
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<p>People with long COVID may face lingering symptoms after their initial infection, or develop new symptoms following some improvement. Symptoms vary from person to person, but long COVID can have profound effects on a person’s physical and cognitive function, their general ability to perform daily activities, and their quality of life.</p>
<p>Despite progress in <a href="https://www.nature.com/articles/s41418-022-01052-6">long COVID research</a>, there remain many unanswered questions about what triggers some people infected with the virus to develop long COVID, the course it might take, and what kinds of treatments may be effective. </p>
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<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-tips-for-young-people-dealing-with-long-covid-from-a-gp-180464?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Five tips for young people dealing with long COVID – from a GP</a></em></p>
<p><em><a href="https://theconversation.com/getting-fit-after-covid-why-you-should-be-strength-training-and-how-to-do-it-190689?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Getting fit after COVID? Why you should be strength training – and how to do it</a></em></p>
<p><em><a href="https://theconversation.com/struggling-to-make-friends-as-an-adult-why-you-should-try-looking-to-older-generations-189814?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Struggling to make friends as an adult? Why you should try looking to older generations</a></em></p>
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<p>Just as those living with long COVID face uncertainty about the nature of their condition and how it may progress, it can be hard to know what to do if someone you care about, such as a friend, family member, or partner, is living with long COVID.</p>
<p>Here are four tips on how you can best support a friend or loved one in this situation.</p>
<h2>1. Create a safe space</h2>
<p>For people with poorly understood medical conditions like <a href="https://www.bmj.com/content/378/bmj-2022-072117">long COVID</a>, seeking understanding from others – including health professionals – <a href="https://www.sciencedirect.com/science/article/pii/S0277953620305888">can be fraught</a>.</p>
<p>Some people with long COVID may face having their experiences discredited or dismissed as psychological. This can come from friends, family or even health professionals, which is sometimes called <a href="https://www.sciencedirect.com/science/article/pii/S2667321522001299">medical gaslighting</a>.</p>
<p>For those living with long COVID, recognition and validation of what they’re going through by the people who matter most to them can be an important antidote to this experience.</p>
<p>Even people with long COVID who haven’t already faced dismissal <a href="https://www.medrxiv.org/content/10.1101/2022.05.26.22275585v1">may fear</a> that others won’t believe they are ill, or that their symptoms will be trivialised. So the best thing you can do is to take your friend or loved one seriously when they say they’re not feeling well (even if they look well).</p>
<p>In doing so, you begin to create a safe space for them to share their experiences. They may need support to be kinder to themselves, and to accept the fact that their symptoms may be long-lasting or recurring. </p>
<p>You may also be able to support them <a href="https://www.sciencedirect.com/science/article/pii/S0277953620305888?casa_token=gHBG2I4HVRoAAAAA:OX9ooZgQgmpi_Nbks62bRLRyvlJFx2is3C0iQY08TeuSFZd5mMObNvgNsA2gVW67CqOU6qnIYg">to balance</a> this with the knowledge that improvement in health, at least to some degree, is possible, and hopefully will be increasingly so with growing scientific knowledge.</p>
<h2>2. Be flexible</h2>
<p>Long COVID often zaps energy, with many people facing extreme fatigue and other debilitating symptoms. So living with this condition can involve making tough choices about where to focus limited energy, often prioritising needs (for example, work, chores, rest) over wants (like socialising). </p>
<p>For people with long COVID, energy <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264331">can fluctuate</a> from week to week, day to day, and hour to hour. Physical or mental exertion can also <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264331">exacerbate symptoms</a>. So you are likely to have your friend cancel on you, at least from time to time.</p>
<p>You may find this frustrating, and indeed, research has shown that people with chronic conditions can face <a href="https://www.sciencedirect.com/science/article/pii/S0277953620305888?casa_token=gHBG2I4HVRoAAAAA:OX9ooZgQgmpi_Nbks62bRLRyvlJFx2is3C0iQY08TeuSFZd5mMObNvgNsA2gVW67CqOU6qnIYg">shrinking social circles</a>. But consider that your friend is likely to feel guilty and vulnerable because they can’t participate in social life like they could before. </p>
<p>Don’t take it personally if they can’t always show up to social gatherings or participate in family life. Instead, let them know you understand that they’re navigating a difficult condition.</p>
<figure class="align-center ">
<img alt="Three young men sitting on a staircase talking." src="https://images.theconversation.com/files/488769/original/file-20221007-12-w1ky2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488769/original/file-20221007-12-w1ky2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488769/original/file-20221007-12-w1ky2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488769/original/file-20221007-12-w1ky2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488769/original/file-20221007-12-w1ky2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488769/original/file-20221007-12-w1ky2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488769/original/file-20221007-12-w1ky2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The challenges of a chronic health condition can disrupt friendships.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/serious-talk-between-bros-shot-male-2139874793">PeopleImages.com - Yuri A/Shutterstock</a></span>
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<h2>3. Encourage (but don’t force) connections</h2>
<p>Research has shown that belonging to social groups and maintaining connections with others <a href="https://www.taylorfrancis.com/books/mono/10.4324/9781315648569/new-psychology-health-catherine-haslam-jolanda-jetten-tegan-cruwys-genevieve-dingle-alexander-haslam">benefits health</a> and wellbeing. </p>
<p>If your friend or loved one’s symptoms make in-person activities difficult, you may find it easier to stay connected with them virtually. If you live in the same household with someone struggling with long COVID, you may want to plan socialising with others outside the household virtually.</p>
<p>Keep in mind their ability to connect virtually may be affected at times by another common long COVID symptom known as “<a href="https://www.theatlantic.com/health/archive/2022/09/long-covid-brain-fog-symptom-executive-function/671393/">brain fog</a>”, which refers to <a href="https://bmjopen.bmj.com/content/bmjopen/12/2/e056366.full.pdf">cognitive symptoms</a> such as difficulties with concentration and memory.</p>
<p>Research on another poorly understood <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109806/">medical condition</a>, chronic fatigue syndrome or myalgic encephalomyelitis, suggests that online forums (such as patient-led forums, Facebook and YouTube), may help people living with the condition maintain a sense of normality, get social support, and make friends who understand what they’re going through. Where possible, help your friend or loved one to access and navigate useful forums that suit their needs.</p>
<h2>4. Offer practical help</h2>
<p>Managing a complex illness can feel like a full-time job. In addition to social support, a person with long COVID may appreciate practical help, for example with household chores, caring responsibilities, being accompanied to doctors’ appointments, negotiating adjustments at work, and more generally having an ally that can advocate on their behalf when they feel less able to. </p>
<p>Each person is different though, so check with your friend or loved one what will be most helpful for them.</p>
<p>Finally, don’t forget to look after yourself. Supporting a friend, partner or loved one through the ups and downs of chronic illness can <a href="https://journals.sagepub.com/doi/pdf/10.1177/014107680109401103">take a significant toll</a> on the carer. In particular, it can be very disappointing to see the person you care for relapse after a period of better health and activity. Ensure you have a support person you can call on when things are feeling difficult.</p><img src="https://counter.theconversation.com/content/190824/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Damien Ridge receives funding from the NIHR for 'Hearing from the unheard: impact of long-COVID in minority ethnic groups in the UK (Hi-COVE)', NIHR, 2022-2023, as well as Roche for ‘Investigating how carers cope, access and use support services – Lessons from Covid-19’, 2021-2023. He has previously received funding from the NIHR for a project entitled, ‘Understanding the support needs of people with chronic fatigue syndrome/ myalgic encephalomyelitis (CFS/ME)’, in 2017.
</span></em></p><p class="fine-print"><em><span>Nisreen Alwan receives research funding from the NIHR for 'STIMULATE ICP: Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways' and 'Hearing from the unheard: impact of long-COVID in minority ethnic groups in the UK (Hi-COVE)' studies. </span></em></p><p class="fine-print"><em><span>Ana Leite does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Start by creating a safe space by showing you beleive them.Ana Leite, Associate Professor in Social and Organisational Psychology, Durham UniversityDamien Ridge, Professor of Health Studies, University of WestminsterNisreen Alwan, Professor of Public Health, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921232022-10-21T14:46:07Z2022-10-21T14:46:07ZEmployers can’t fill vacancies, but many do surprisingly little to help workers return after a long illness<figure><img src="https://images.theconversation.com/files/488791/original/file-20221007-26-snsb79.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'I'm sure you'll be able to take on a few extra tasks.'</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/businesswomen-discussing-project-results-planning-work-1184389312">fizkes</a></span></figcaption></figure><p>The UK was supposed to be facing a spike in unemployment after the pandemic furlough schemes ended, but instead the job market is the <a href="https://www.employment-studies.co.uk/resource/labour-market-statistics-september-2022">tightest in a generation</a>. Given that there are also more vacancies than active job seekers and many sectors are struggling with skill shortages, you might expect to see pay rising, productivity improving and new job opportunities for those at the margins.</p>
<p>Yet real <a href="https://www.resolutionfoundation.org/press-releases/fifteen-years-of-income-stagnation-have-left-families-brutally-exposed-to-the-current-cost-of-living-crisis">pay growth</a> has been stagnating for at least a decade. <a href="https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/ukproductivityintroduction/apriltojune2021">Productivity</a> has only recently climbed back to pre-2008 levels. And most worryingly, we are seeing a <a href="https://www.employment-studies.co.uk/news/all-change-government-returns-we-need-new-plan-jobs-and-growth">participation crisis</a>, with a <a href="https://www.employment-studies.co.uk/resource/labour-market-statistics-september-2022">record 640,000 increase</a> in economically inactive people since the start of the pandemic.</p>
<p>The reasons why people choose not to work have changed considerably over time, as you can see from the graph below. “Looking after family or home” (the black line) has declined significantly over the past couple of decades while the number of students has increased (the yellow line). </p>
<p><strong>Reasons for not working, 2002-22</strong></p>
<p>But perhaps the most dramatic change has been the number of people with long-term or chronic illnesses who have been leaving work altogether (the blue line). <a href="https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/bulletins/uklabourmarket/october2022">With 170,000 people</a> swelling the ranks of this group in the last month alone, they now total nearly 2.5 million – the largest number of long-term sick out of work in our history. The last time the numbers approached this level was two decades ago. </p>
<h2>Explaining the shift</h2>
<p>Long NHS waiting lists may account for some of the rise, especially among older workers with multiple or complex conditions and those with mental health problems. Long COVID is also probably <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19latestinsights/infections#long-covid">playing a part</a>, with 2.3 million sufferers and around 1.1 million (46%) with symptoms persisting for at least a year.</p>
<p>Another factor is people with long-term illnesses. <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.28067">Only 60%</a> of working age cancer survivors are back in work a year after finishing treatment, for instance. Cancer survivors are frequently <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2354.2007.00729.x">highly motivated</a> to resume work as it represents a return to “<a href="https://psycnet.apa.org/record/2000-08700-009">normal</a>” life and can enhance their financial independence. </p>
<p>However, the cancer itself, its treatment and side effects often increase the risk of <a href="https://jamanetwork.com/journals/jama/article-abstract/183387">early withdrawal</a> from the labour market. Up to <a href="https://www.tandfonline.com/doi/full/10.1080/0284186X.2016.1213417">53% of cancer survivors</a> have to give up work, and are <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007569.pub3/full">1.4 times more likely</a> to be unemployed than the average person. </p>
<p>For those that are able, the pathway back to work can be difficult. Employers need to exercise compassion and recognise a returning worker’s performance may be impaired for a while. A <a href="https://pubmed.ncbi.nlm.nih.gov/22086407/">Norwegian study</a> found that 31% of employed cancer survivors reported a reduced ability to carry out physical work because of cancer, and almost a quarter reported reduced cognitive ability. </p>
<p>Many employers also fail to help people with long-term illnesses to stay in or return to the labour market – despite the high vacancy rates. I recently co-produced a <a href="https://www.employment-studies.co.uk/resource/cancer-and-employment-survey">survey of 1,241</a> working age cancer survivors in the UK, which wasn’t peer-reviewed because the cohort isn’t representative of the population as a whole, but hopefully still gives a good insight into people’s experiences. </p>
<p>Many felt unsupported and some were even dismissed or made redundant on their return to work. A third were not able to phase their return to work and 25% had to take annual leave to receive chemotherapy or even surgery. Most returners reduced their working hours, with the proportion in full-time work falling from 73% before treatment to 46% afterwards, despite over half of survivors being the primary breadwinner in their household. </p>
<p>Most respondents said the emotional impact of cancer treatment far exceeded the physical consequences, and 93% reported side-effects such as fatigue (93%), brain fog (68%), anxiety (60%), loss of confidence (55%) and pain (54%). Each is a hidden impairment, which proved difficult for many survivors. One said:</p>
<blockquote>
<p>One day my boss said to me, ‘Well don’t expect any sympathy from us because you look marvellous.’</p>
</blockquote>
<p>Another recounted:</p>
<blockquote>
<p>I suggested that my workload be decreased for a few months, even accepting a lower salary. But my boss accused me of a go-slow attitude and eventually left me with no other option than retirement.</p>
</blockquote>
<p>It’s worth bearing in mind that cancer is a <a href="https://www.cancerresearchuk.org/about-cancer/coping/practically/the-disability-discrimination-act-equality-act-and-cancer">protected characteristic</a> under the Equalities Act. This means it is illegal to discriminate against someone for that reason. </p>
<h2>The way forward</h2>
<p>I have <a href="https://theconversation.com/how-employers-can-help-cancer-survivors-return-to-work-based-on-my-own-experience-128568">previously written</a> about my own experience of cancer treatment and my eventual return to work, so I particularly appreciate the benefit of having a supportive employer. Perhaps it is little wonder that, in the face of difficulties at work, so many are opting for economic inactivity or early retirement. </p>
<p>Having 2.5 million working-age people with long-term illnesses who are economically inactive exacerbates skill shortages, increases inflation and stifles the economic growth which the Truss government was so focused on. These people are usually not susceptible to sanctions or so-called “benefit conditionality”, so can’t be punished back to work.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488792/original/file-20221007-20-at6qvv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Builder sitting at the end of a corridor" src="https://images.theconversation.com/files/488792/original/file-20221007-20-at6qvv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488792/original/file-20221007-20-at6qvv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488792/original/file-20221007-20-at6qvv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488792/original/file-20221007-20-at6qvv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488792/original/file-20221007-20-at6qvv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488792/original/file-20221007-20-at6qvv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488792/original/file-20221007-20-at6qvv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">‘It just gets better and better.’</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stressed-despair-staff-logistic-business-sittng-1213988563">interstid</a></span>
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</figure>
<p>The answer lies in helping many more to avoid falling out of work in the first place and, if they do leave the labour market, deploying compassionate, personalised and skilled job coaching and support to encourage them to return. The good news is that researchers are developing ever more <a href="https://link.springer.com/article/10.1007/s11764-019-00844-z">innovative ways</a> of helping employers to make accommodations for returning cancer survivors, often involving job redesign, peer support and the training of line managers. </p>
<p>On the other hand, it is not a great time for the Department of Work and Pensions to be cutting <a href="https://www.mirror.co.uk/news/politics/more-3000-dwp-work-coaches-26670949">3,000 job coaches</a>. The fact that the UK government is also keen to increase its use of sanctions against part-time workers who are unwilling to increase their hours is not a promising sign either. Let’s hope for a change of approach soon, before many of the long-term sick are lost to the economy forever.</p><img src="https://counter.theconversation.com/content/192123/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Bevan receives funding for individual studies, via his employer the Institute for Employment Studies, from the Department of Work and Pensions and The Economic & Social Research Council among others. He is affiliated with the social enterprise Working With Cancer for whom he volunteers as an ambassador. </span></em></p>More than half of cancer survivors have to give up work, and employers are partly to blame.Stephen Bevan, Head of HR Research Development, Institute for Employment Studies, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1911912022-10-04T15:45:56Z2022-10-04T15:45:56ZDiabetes in South Africa: 60% aren’t being screened for complications, according to new study<figure><img src="https://images.theconversation.com/files/487728/original/file-20221003-18-l1d9q2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eleven percent of South African adults live with diabetes. </span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>The world is experiencing a <a href="https://www.who.int/news-room/fact-sheets/detail/diabetes">steep rise</a> in the number of people living with diabetes, a chronic condition of significant public health concern. Many developing countries like South Africa now bear the greatest burden. </p>
<p>Diabetes refers to a high level of glucose in the blood.
Several factors contribute to diabetes, but obesity and unhealthy lifestyle behaviours are the major drivers. It is a costly disease, and it reduces the quality of life and lifespan, especially if not properly managed. </p>
<p>Eleven percent of South African adults now <a href="https://idf.org/our-network/regions-members/africa/members/25-south-africa.html">live with diabetes</a>, the highest prevalence in Africa. Most of them have poorly controlled diabetes. And many others are yet to be diagnosed. A lot of people develop <a href="https://www.cdc.gov/diabetes/managing/problems.html#:%7E:text=Common%20diabetes%20health%20complications%20include,how%20to%20improve%20overall%20health.">complications</a> as a result of poorly controlled diabetes. These include eye problems, kidney disease and cardiovascular diseases. Some even develop wounds that don’t heal, resulting in limb amputation. </p>
<p>When people develop such complications, they spend more money on healthcare. And it places a greater burden on the already overstretched health system. Some even lose their livelihood which, in turn, affects their families.</p>
<p>There have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565451/">some</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709478/">studies</a> in South Africa looking at the level of screening for complications for people living with diabetes. But there’s very little focus on the primary healthcare level. And some of these <a href="https://www.researchgate.net/publication/14037605_Public_sector_primary_care_of_diabetics_-_A_record_review_of_quality_of_care_in_Cape_Town">studies</a> were conducted many years ago, so the data may no longer be valid. </p>
<p>It is imperative to determine the current situation, especially at primary healthcare level. Our recent <a href="https://www.researchgate.net/publication/360198427_Coverage_of_diabetes_complications_screening_in_rural_Eastern_Cape_South_Africa_A_cross-sectional_survey">study</a> focused on the Eastern Cape province. It’s one of the poorest provinces in South Africa, with a high prevalence of poorly controlled diabetes.<br>
We assessed the extent of screening for diabetes-related complications at primary healthcare clinics in this province.</p>
<p>We found that the rate of screening for these complications was very low. Our findings are similar to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709478/">research</a> done in another rural province in the country. This points to the need to promptly implement measures to improve screening coverage for people with diabetes in South Africa. Doing this will improve health outcomes and quality of life, and reduce the incidence of devastating diabetes complications.</p>
<h2>Checking for complications</h2>
<p>To keep blood glucose levels under control and avoid complications, people with diabetes need to pay detailed attention to their health. They must be involved in their care, live a healthy life, and undergo important tests and examinations that help to quickly identify potential problems. </p>
<p>There are <a href="http://www.jemdsa.co.za/index.php/JEMDSA/article/view/647">guidelines</a> for diabetes management and complications screening in South Africa. Healthcare providers also have a duty to check whether these individuals’ blood glucose is under control, so they don’t develop complications which can cut their life short or disable them. </p>
<p>Primary healthcare clinics are the entry points into the healthcare system. Most people with diabetes are first managed at these facilities. Here they receive medication and are supposed to check their blood glucose level at every visit. </p>
<p>In addition, primary healthcare providers are supposed to check patients’ eyes and kidney function when they make the diagnosis – and every year after that. Healthcare workers are also supposed to check the patients’ feet at least once a year. Patients at higher risk of developing foot ulcers need more frequent check-ups to prevent complications like leg amputation. </p>
<h2>Our study</h2>
<p>We wanted to find out how the people living with diabetes in some rural areas of the Eastern Cape, South Africa are being managed. We recruited participants with diabetes from six primary healthcare facilities. By asking them questions and by looking at their medical records, we determined if these measures and examinations were in place at these primary healthcare clinics.</p>
<p>Our analysis showed that out of 372 people, only 71 (19%) of them had been checked for blood glucose control in the past year. Sixty (16%) of them had been assessed for kidney function and 33 (8.9%) had been checked for blood cholesterol levels. Just 52 (14%) had undergone eye examinations in the past year. </p>
<p>Foot examination, which helps to prevent leg amputation, was done for only 9 (2.3%). More than half (60%) of these patients had not undergone any form of examination for these potential complications in the past year. </p>
<p>None of them had undergone all of these five important screenings.</p>
<h2>Way forward</h2>
<p>Our study shows that without urgent intervention, a lot of people with diabetes will soon develop complications that could be prevented through proper screenings. This will affect the individuals, their families, jobs, and even the overburdened health system. </p>
<p>Prevention is cheaper than cure. Understanding the potential reasons for the gaps in diabetes management and finding effective solutions for improving screening coverage will cut healthcare costs, prolong the life of patients and enable them to lead a quality life. </p>
<p>There are a number of approaches that the country can take. For instance <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3617530/">mobile health technology</a> can be used as a tool to facilitate screening. A similar approach is being used in developed countries. As a result, many of them have been able to cut down the number of <a href="https://link.springer.com/article/10.1007/s00125-018-4711-2">diabetes-related complications</a>. </p>
<p>Other countries have also embraced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398859/">technology-based solutions</a> to train community health workers to conduct some of these examinations under the guidance of experts.</p><img src="https://counter.theconversation.com/content/191191/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eyitayo Omolara Owolabi received funding for her PhD from South African National Research Foundation. </span></em></p><p class="fine-print"><em><span>Anthony Idowu Ajayi is affiliated with African Population and Health Research Center. </span></em></p>Most people with diabetes are poorly controlled. This makes them vulnerable to complications like eye problems, kidney disease, and even amputations.Eyitayo Omolara Owolabi, Postdoctoral fellow, Arizona State UniversityAnthony Idowu Ajayi, Associate research scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1904292022-09-29T20:05:08Z2022-09-29T20:05:08ZWhy has my cold dragged on so long? And how do I know when it’s morphed into something more serious?<figure><img src="https://images.theconversation.com/files/483890/original/file-20220912-7256-6grcdr.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C6120%2C4076&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-lying-on-bed-while-blowing-her-nose-3807629/">Photo by Andrea Piacquadio/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Common colds are caused by viruses. There are no effective cures, and antibiotics do not work on viruses, so treatment is targeted at managing the symptoms until your immune system has cleared the cold.</p>
<p>So why might someone go to a doctor at all for a cold?</p>
<p>Well, occasionally a cold might turn into something more serious requiring assessment and specific treatment, and a GP visit could be warranted. Or you may just want reassurance and advice.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sore-throats-suck-do-throat-lozenges-help-at-all-184454">Sore throats suck. Do throat lozenges help at all?</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&rect=0%2C50%2C6709%2C4416&q=45&auto=format&w=1000&fit=clip"><img alt="A woman blows her nose." src="https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&rect=0%2C50%2C6709%2C4416&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483887/original/file-20220912-54657-jcnlj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Occasionally a cold might turn into something more serious requiring assessment and specific treatment.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-blowing-nose-7195040/">Photo by Karolina Grabowska/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Don’t rush to the GP for something totally normal</h2>
<p>Problems arise when there too many unwarranted visits to GPs for cold symptoms.</p>
<p>Studies have shown <a href="https://www.annfammed.org/content/11/1/5">antibiotics</a> are <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja16.01042">still prescribed widely</a> for viral colds, even though they don’t help, and this contributes to antibiotic resistance. It hastens the arrival of an era when many antibiotics simply don’t work at all.</p>
<p>On average, children have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152362/">four to six colds</a> per year, while in adults the average is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152362/">two to three</a>.</p>
<p>Some people are more <a href="https://www.sciencedirect.com/science/article/abs/pii/S1530156705601189?via%3Dihub">prone</a> to colds, but we don’t know exactly why.</p>
<p>The usual cold persists about one week, although 25% last two weeks. In one <a href="https://journals.asm.org/doi/10.1128/jcm.35.11.2864-2868.1997">study</a> with 346 adults, the infection lasted 9.5 to 11 days. </p>
<p>Cold symptoms may last longer in younger children. One <a href="https://publications.aap.org/pediatrics/article-abstract/87/2/129/56810/Upper-Respiratory-Tract-Infections-in-Young?redirectedFrom=fulltext">study</a> showed an average duration of colds ranged from 6.6 to 9 days. But symptoms lasted more than 15 days in 6.5% of 1-3 year old children in home care, and 13.1% of 2-3 year old children in day care.</p>
<p>A cough tends to last longer than other symptoms, and often beyond the actual viral infection. The average <a href="https://www.annfammed.org/content/11/1/5">duration</a> of a cough is about 17.8 days.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man coughs into his elbow." src="https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483889/original/file-20220912-54657-4uy5r1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A cough tends to last longer than other symptoms.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-sick-man-covering-his-mouth-4031634/">Photo by Edward Jenner/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Discoloured sputum, cough or snot</h2>
<p>Discoloured mucus in snot or cough is a common trigger for requesting antibiotics from a GP. But as we know, antibiotics are useless against a virus. They only work against bacterial infection. </p>
<p>In fact, thick or coloured nasal mucus secretion is common following colds. Only a tiny proportion <a href="https://europepmc.org/article/pmc/pmc7151789">involve</a> bacterial infection.</p>
<p>When it happens, this is termed <a href="https://www.nps.org.au/australian-prescriber/articles/treating-acute-sinusitis-3">acute rhinosinusitis</a>. But antibiotics are not recommended unless it lasts more than ten to 14 days and there are <a href="https://europepmc.org/article/pmc/pmc7151789">signs</a> of bacterial sinusitis infection, such as:</p>
<ul>
<li>symptoms worsening after improvement in the original cold</li>
<li>return of fever and</li>
<li>strong facial pain.</li>
</ul>
<p>A prolonged cough after colds is usually caused by an irritated throat or the clearing of sticky mucus coming down from the nose. The cough may sound moist (so wrongly called “chesty”) due to the phlegm, but only small amounts of phlegm are coughed up. </p>
<p>Yellow or green coloured mucus is often interpreted as a <a href="http://theconversation.com/health-check-what-you-need-to-know-about-mucus-and-phlegm-33192">sign</a> of bacterial infection.</p>
<p>But yellow or green sputum alone <a href="https://www.tandfonline.com/doi/full/10.1080/02813430902759663">does not</a> mean you have a serious bacterial infection. One study found being prescribed antibiotics under these circumstances <a href="https://erj.ersjournals.com/content/38/1/119">failed</a> to shorten recovery time. </p>
<p>Nasal saline sprays and washes can be used to rinse out the nose and sinuses and possibly <a href="https://dtb.bmj.com/content/57/4/56">shorten</a> rhinosinusitis and cough after colds.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483891/original/file-20220912-68568-ej88qo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A cold can make you feel rubbish for quite a while.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/apartment-bed-carpet-chair-269141/">Photo by Pixabay, via Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Could it just be hayfever, or another underlying issue?</h2>
<p>Hayfever or allergic rhinitis is a common cause for prolonged symptoms after a cold, especially cough and nasal congestion and maybe also sneezing. </p>
<p>The damage in the upper airways following a viral infection may allow airborne allergens to trigger hayfever. Self-medicating with antihistamines, nasal saline spray or intranasal steroids is worthwhile if <a href="https://theconversation.com/health-check-why-do-i-have-a-cough-and-what-can-i-do-about-it-119172">allergic rhinitis</a> is suspected. </p>
<p>There may be other reasons for persistence of cough, such as exacerbation of underlying asthma or chronic lung disease. If so, this may require a visit to your GP.</p>
<h2>What about bronchitis or pneumonia?</h2>
<p>Many people worry about developing a chest infection after a cold. </p>
<p>Acute bronchitis is a self-limiting infectious disease characterised by acute cough with or without sputum but without <a href="https://www.nhs.uk/conditions/pneumonia/">signs of pneumonia</a> (such as high temperatures and feeling breathless). Most acute bronchitis cases are caused by viruses. Antibiotics are often prescribed, but produce <a href="https://www.tandfonline.com/doi/full/10.1080/14787210.2016.1193435">no significant clinical improvement</a> compared with placebo, so are not recommended.</p>
<p>Pneumonia is a potentially serious secondary disease that <a href="https://pubmed.ncbi.nlm.nih.gov/28159155/">may follow</a> an episode of flu in a small number of cases, but is <a href="https://www.ncbi.nlm.nih.gov/books/NBK532961/">relatively rare</a> following a cold. Symptoms and signs of pneumonia feature heavily in the list of warning signs that signal the need for a medical assessment. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man looks at his phone." src="https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486977/original/file-20220928-12-fzoana.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sometimes, contacting your GP is a good idea.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>When should I seek medical help for a cough or a cold?</h2>
<p>Contact a GP if you experience:</p>
<ul>
<li>shortness of breath or trouble breathing</li>
<li>feeling faint or dizzy</li>
<li>chest pain</li>
<li>dehydration </li>
<li>fever or cough symptoms that improve but then return or worsen</li>
<li>worsening of chronic medical conditions such as asthma.</li>
</ul>
<p>This is not a complete list, but may guide you on what to expect and what to watch out for. </p>
<p>You might also contact your GP (perhaps for a telehealth consult) if you are finding your symptoms very unpleasant, or are concerned your condition is more serious or prolonged than expected. You might just need reassurance and education about self care options.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/forget-nose-spray-good-sex-clears-a-stuffy-nose-just-as-effectively-and-is-a-lot-more-fun-167901">Forget nose spray, good sex clears a stuffy nose just as effectively — and is a lot more fun</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/190429/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Problems arise when there are too many unwarranted visits to GPs for cold symptoms. Occasionally, though, a cold might turn into something that needs specific diagnosis and treatment.David King, Senior Lecturer in General Practice, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1914252022-09-27T16:25:51Z2022-09-27T16:25:51ZHurricane Ian: Older adults have many reasons for not evacuating – here’s why it’s important to check on aging neighbors<figure><img src="https://images.theconversation.com/files/486845/original/file-20220927-12-n2vv9v.jpg?ixlib=rb-1.1.0&rect=37%2C59%2C4955%2C3121&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hurricane Ian pounded western Cuba on Sept. 26, 2022, on its way to the Florida coast.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/CubaTropicalWeather/74d15821cd974efea0578a7b6d960f80/photo">AP Photo/Ramon Espinosa</a></span></figcaption></figure><p>As mandatory evacuations for Hurricane Ian began in Florida and <a href="https://theconversation.com/3-reasons-hurricane-ian-poses-a-major-flooding-hazard-for-florida-a-meteorologist-explains-191341">the warnings about damaging wind and flooding</a> intensified, I called my aging parents to check in.</p>
<p>Being <a href="https://nursing.umich.edu/faculty-staff/faculty/sue-anne-bell">a disaster researcher</a>, my concern for them was already in high gear, even though they weren’t directly in an evacuation zone. My dad takes medications that require refrigeration, special needles and a sterile environment to administer. My mom is in the early stages of dementia. Both are not as spry as they used to be.</p>
<p>I heard the worry in their voice about their safety, about my dad’s health needs, and about what might happen to their house. </p>
<p>As I sat at home hundreds of miles away, I thought about all the reasons why leaving isn’t always a clear decision.</p>
<figure class="align-center ">
<img alt="A woman sits on a porch with a dog as floodwater covers the stairs. A sign reading 'private property: no tresspassing' is on the house." src="https://images.theconversation.com/files/486871/original/file-20220927-22-rdt3oi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/486871/original/file-20220927-22-rdt3oi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486871/original/file-20220927-22-rdt3oi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486871/original/file-20220927-22-rdt3oi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486871/original/file-20220927-22-rdt3oi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486871/original/file-20220927-22-rdt3oi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486871/original/file-20220927-22-rdt3oi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Concerns about health and home security are two reasons older adults might fear evacuating during disasters like Hurricane Harvey in 2017.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/rena-brannon-sits-on-the-porch-of-her-home-which-surrounded-news-photo/841968094">Scott Olson/Getty Images</a></span>
</figcaption>
</figure>
<p>As in other recent hurricanes, some residents will choose to ride out the storm in their homes, despite recommendations to evacuate. The risks can be high – sheltering in place during <a href="https://www.nhc.noaa.gov/aboutsshws.php">a major hurricane</a>, with flooding rainfall, storm surge and powerful winds, can put lives at risk. The damage to neighborhoods after the storm, including loss of power can also be dangerous, and supplies can be hard to find. </p>
<p>It is easy to dismiss those who stay in the storm’s path as uninformed, but for older adults, evacuating can come with its own consequences. Researchers have found that older adults may <a href="https://doi.org/10.1017/dmp.2016.197">not be well prepared</a> to <a href="https://doi.org/10.1159/000439168">address the health risks</a> that occur during disasters. Being ready to either evacuate or stay put is part of that.</p>
<p>Understanding and addressing the underlying reasons behind why seniors do not evacuate <a href="https://doi.org/10.1017/dmp.2020.80">can help to improve disaster response</a> for this population. </p>
<h2>Evacuation can be expensive</h2>
<p>For seniors who live on a fixed income, evacuation may not always be feasible for their budget. Evacuating has many associated – and hidden – costs.</p>
<p>Transportation, food and housing can add up quickly. Shelters may be intimidating.</p>
<figure class="align-center ">
<img alt="A man stands in the door of a mobile home as his dog runs out to greet two police officers." src="https://images.theconversation.com/files/486847/original/file-20220927-2496-uadpnp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/486847/original/file-20220927-2496-uadpnp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486847/original/file-20220927-2496-uadpnp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486847/original/file-20220927-2496-uadpnp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486847/original/file-20220927-2496-uadpnp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486847/original/file-20220927-2496-uadpnp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486847/original/file-20220927-2496-uadpnp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pets are another reason some people don’t evacuate, even when officers urge them to leave.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/GH-20190902-9966/24a414afc15a4193b6db1bdaff0ebf2b/photo">AP Photo/Gerald Herbert</a></span>
</figcaption>
</figure>
<p>A survey we conducted in 2020 with 2,256 older adults across the U.S. found that about <a href="https://doi.org/10.1017/dmp.2020.80">1 in 4 (24%)</a> indicated it would be difficult to afford to stay somewhere else for a week if necessary. And with so many storms happening so frequently, costs related to multiple evacuations can quickly add up.</p>
<h2>Concerns about taking care of chronic illness</h2>
<p>Up to 60% of older adults in America have <a href="https://www.nia.nih.gov/health/supporting-older-patients-chronic-conditions#:%7E:text=Approximately%2085%25%20of%20older%20adults,for%20Disease%20Control%20and%20Prevention.">more than one chronic health condition</a>. Diabetes, kidney disease, and even cancer are prime examples of conditions that require daily attention in order to keep an optimum level of health.</p>
<p>When our research team surveyed older adults who use essential medical equipment that requires electricity, <a href="https://doi.org/10.1017/dmp.2020.80">just 25% had an alternative power source</a> for that equipment. </p>
<p>Further, oxygen tanks, home dialysis machines, chemotherapy and strict dietary and medication regimens can be a part of life-saving daily routines. Without this equipment, breakdowns in health can occur, which can have <a href="https://pubmed.ncbi.nlm.nih.gov/35171505/">long-lasting effects on health</a>.</p>
<figure class="align-center ">
<img alt="An older man lies on a cot in an evacuation center. He has a wrist band and is clutching a bottle of water." src="https://images.theconversation.com/files/486849/original/file-20220927-22-830g3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/486849/original/file-20220927-22-830g3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486849/original/file-20220927-22-830g3z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486849/original/file-20220927-22-830g3z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486849/original/file-20220927-22-830g3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486849/original/file-20220927-22-830g3z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486849/original/file-20220927-22-830g3z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Shelters can be intimidating for older residents.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakHurricanes/a88f9c23ecc24000bc13fc1d720be0b1/photo">AP Photo/Gerald Herbert</a></span>
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</figure>
<p>Older adults may be hesitant to break these care routines, or worry about being away from important equipment that is not portable.</p>
<h2>Mobility issues</h2>
<p>Difficulty moving around, losing balance and unsteadiness are common changes that occur with aging. The risk of falling or injury while moving more than usual due to the storm preparations is a considerable challenge.</p>
<p>For seniors with limited mobility, the challenges of getting prepared to evacuate and then moving out of their homes and into a crowded and chaotic situation <a href="https://doi.org/10.1017/dmp.2020.80">can be a serious deterrent</a>.</p>
<h2>Social isolation</h2>
<p>Social isolation is also a well-documented issue among older adults. Older adults who live alone, who are caregivers for loved ones or who don’t speak English are especially at risk. These individuals may lack the awareness and resources to evacuate. </p>
<p>That’s why evacuation planning guidelines recommend <a href="https://www.ready.gov/evacuation">checking in on neighbors</a> to see if they need help. Programs, run by governments or community groups, also exist in some areas to <a href="https://www.miamidade.gov/global/service.page?Mduid_service=ser1470238193996672">help seniors evacuate</a>. </p>
<h2>Trusting in past experiences</h2>
<p>Many seniors have chosen to stay home through decades of strong storms and hurricanes. Hurricane Ian may not seem any different – but it is.</p>
<p>The Gulf Coast near Tampa has not seen direct impacts of a hurricane in <a href="https://apnews.com/article/floods-science-florida-gulf-of-mexico-tampa-e0ff179a0c93debd154897e292f539f9">more than 100 years</a>. The tendency to underestimate the severity of a disaster and its potential effects is called <a href="https://psychologenie.com/insight-into-concept-of-normalcy-bias-in-psychology">normalcy bias</a>. The idea that “if it hasn’t happened before, why should it happen now?” is one that keeps many at home rather than evacuating.</p>
<figure class="align-center ">
<img alt="Bare shelves that once held bottled water in a store with shoppers." src="https://images.theconversation.com/files/486852/original/file-20220927-22-qt8xga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/486852/original/file-20220927-22-qt8xga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486852/original/file-20220927-22-qt8xga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486852/original/file-20220927-22-qt8xga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486852/original/file-20220927-22-qt8xga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486852/original/file-20220927-22-qt8xga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486852/original/file-20220927-22-qt8xga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Store shelves in Orlando were bare of bottled water and other storms provisions a few days before Hurricane Ian’s arrival. The crowds can be difficult for some older residents to manage.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TropicalWeatherFlorida/98548e048e214454a16c7c015596a12a/photo">AP Photo/John Raoux</a></span>
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<p>Florida Attorney General Ashley Moody told reporters, “<a href="https://www.youtube.com/watch?v=vN7syB8BfLo">This could be the storm that we have all feared</a>.” She is right to be scared.</p>
<p>Hurricane Ian is expected to <a href="https://www.nhc.noaa.gov/refresh/graphics_at4+shtml/042148.shtml?peakSurge#contents">cause huge damages</a> as it nears the coast of Florida, and it will almost certainly have long term effects for many of its senior residents. Building supportive communities that can help older adults prepare for – and become resilient to – disasters are needed now more than ever.</p><img src="https://counter.theconversation.com/content/191425/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Research reported in this publication was supported by National Institute on Aging of the National Institutes of Health.</span></em></p>For some people, the risks associated with leaving can seem more dangerous than the storm.Sue Anne Bell, Assistant Professor of Nursing, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1870682022-09-15T02:59:09Z2022-09-15T02:59:09ZHow do we support Indigenous people in Australia living with musculoskeletal conditions?<figure><img src="https://images.theconversation.com/files/481245/original/file-20220826-23-r0mowc.jpg?ixlib=rb-1.1.0&rect=5%2C130%2C3783%2C2545&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mri-scan-human-spine-168563063">shutterstock</a></span></figcaption></figure><p>There have been national, state and local campaigns to “<a href="https://www.closingthegap.gov.au/national-agreement/targets">Close the Gap</a>” in Australia. Despite this, considerable health gaps still exist between Indigenous and non-Indigenous people.</p>
<p>Musculoskeletal conditions are an area of health where there is a significant difference between Indigenous and non-Indigenous people. Although Indigenous people experience musculoskeletal conditions <a href="https://pubmed.ncbi.nlm.nih.gov/29245188/">more</a>, their access to high-quality and culturally informed support remains low.</p>
<p>Musculoskeletal conditions can have a considerable <a href="https://pubmed.ncbi.nlm.nih.gov/22392923/">effect</a> on people’s lives. Such conditions can affect a person’s ability to walk, complete simple tasks at home without help, and participate in sports or work.</p>
<p>Government health organisations need to provide better support for Indigenous people suffering from these conditions by encouraging culturally safe community-based care.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/first-nations-mothers-are-more-likely-to-die-during-childbirth-more-first-nations-midwives-could-close-this-gap-182935">First Nations mothers are more likely to die during childbirth. More First Nations midwives could close this gap</a>
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<h2>What are musculoskeletal conditions?</h2>
<p><a href="https://www.health.gov.au/health-topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-musculoskeletal-conditions#:%7E:text=We%20are%20providing%20%244%20million,and%20training%20for%20health%20professionals">Musculoskeletal conditions</a> include disorders that affect the bones, muscles and joints such as back pain and osteoarthritis. They affect approximately one in three <a href="https://pubmed.ncbi.nlm.nih.gov/35505334/#:%7E:text=In%202019%2C%2022.3%25%20and%2039.8,particular%20females%20and%20older%20Australians">Australians</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1560044779941302272"}"></div></p>
<p>Internationally, low back pain is the leading cause of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext">disability</a>, and osteoarthritis is the leading cause of physical activity <a href="https://pubmed.ncbi.nlm.nih.gov/24553908/">limitation</a>. Both of these ailments are more common in <a href="https://pubmed.ncbi.nlm.nih.gov/29245188/">Indigenous people</a>, who are 20-50% more likely to have osteoarthritis and 10% more likely to report current back pain than the non-Indigenous population in Australia. </p>
<p>Musculoskeletal conditions have also been shown to contribute to the development of <a href="https://pubmed.ncbi.nlm.nih.gov/30249247/#:%7E:text=Pooled%20adjusted%20estimates%20from%20these,total%20n%20%3D%202%2C686%2C113%20people">chronic diseases</a> such as diabetes and cardiovascular disease. With 46% of Australia’s Indigenous population having at least <a href="https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/national-aboriginal-and-torres-strait-islander-health-survey/latest-release">one</a> chronic condition, this may lead to even <a href="https://pubmed.ncbi.nlm.nih.gov/22818936/">higher</a> rates of chronic diseases.</p>
<p>Many Indigenous people resign themselves to being in <a href="https://pubmed.ncbi.nlm.nih.gov/15885010/">pain</a> and living with their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808686/">condition</a>. The social impact of living with these conditions is important to consider. For some First Nations people, it has the potential to restrict participation in activities of cultural significance and minimising connection with family and Country. </p>
<p>For example, the ability to care for and connect with extended family, attend community and family gatherings and enjoy activities on Country. These <a href="https://pubmed.ncbi.nlm.nih.gov/22392923/">limitations</a> often have considerable emotional effects on individuals, leading to feelings of anger, depression and fear.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/colonial-ideas-have-kept-nz-and-australia-in-a-rut-of-policy-failure-we-need-policy-by-indigenous-people-for-the-people-188583">Colonial ideas have kept NZ and Australia in a rut of policy failure. We need policy by Indigenous people, for the people</a>
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<h2>Community-based care is needed</h2>
<p>Indigenous people’s <a href="https://pubmed.ncbi.nlm.nih.gov/24127305/">access</a> to health-care services to manage pain is half the expected rate compared to non-Indigenous people. Part of the reason for lower health care access is due to <a href="https://pubmed.ncbi.nlm.nih.gov/25945587/">negative experiences</a> with health-care services due to discriminatory attitudes toward pain from health-care providers. Unfortunately this is a common occurrence for Indigenous people. More than half (53%) of all Indigenous people have <a href="https://www.westernsydney.edu.au/__data/assets/pdf_file/0009/1201203/OMAC1694_Challenging_Racism_Report_4_-_FINAL.pdf">experienced racism</a> when when seeking health care. </p>
<p>Ways to increase Indigenous peoples’ access to health services is for them to have better support with self-managing their condition. In addition, community-based approaches to health care would provide a safer space for these patients. The <a href="https://www.health.gov.au/initiatives-and-programs/indigenous-australians-health-programme">Indigenous Australians’ Health Programme</a> and other funding bodies must work with communities, clinicians, and researchers to deliver programs addressing musculoskeletal conditions and chronic diseases. These programs need to ensure local communities are at their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999419/">centre</a> and cultural safety for participants is a priority. Such programs could be led by community-based allied health clinicians, but should include a range of health professionals to ensure optimal care is provided that addresses all factors related to musculoskeletal conditions.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/indigenous-people-with-disabilities-face-racism-and-ableism-whats-needed-is-action-not-another-report-187528">Indigenous people with disabilities face racism and ableism. What's needed is action not another report</a>
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<h2>Health care needs to include cultural safety</h2>
<p>A whole of system approach is required to improve access to health care for Indigenous people in Australia. National, state, and local services must work together to ensure culturally safe care is provided, placing Indigenous clients and local communities at its <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999419/">core</a>. This shift will likely require changes in how clinicians deliver care, how the services organise care, and how the health-care system supports this care.</p>
<p>Ineffective communication is often sighted as a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808686/">barrier</a> to care for Indigenous people. This is why clinicians building connections and rapport with the Indigenous community they are treating is important. Undertaking training in cultural safety and effective communication strategies is essential to assist clinicians in providing optimal care.</p>
<p>To improve health services, programs providing care for musculoskeletal conditions should aim to partner with Aboriginal Community Controlled Health Organisations and ensure Indigenous people are trained and employed as part of the team. The health system should also ensure <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808686/">policies prioritise</a> these employment opportunities as well as the importance of providing culturally safe care and working with local Indigenous communities.</p>
<p>A person’s musculoskeletal pain and the presence of chronic diseases are often intertwined. We must develop community-based models of care to address these conditions in Indigenous people, and ensure culturally safe care is being provided.
These changes will require ongoing training for health-care staff. </p>
<p>The fundamental shift is the inclusion of local Indigenous communities in all health care initiatives. These improvements will help ensure Indigenous people have the opportunity to self-manage their musculoskeletal pain, general health and well being.</p><img src="https://counter.theconversation.com/content/187068/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Williams receives funding from National Health and Medical Research Council of Australia. </span></em></p><p class="fine-print"><em><span>Jane Linton and Simon Davidson do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Government health organisations need to provide better support for Indigenous people suffering from musculoskeletal conditions.Simon Davidson, PhD Candidate, University of NewcastleChristopher Williams, Associate Professor, University of SydneyJane Linton, Affiliate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.